89787A - Summers

"muttNNE ®cAnnA ❑ CREME & FILL (ll� N9 89787 (� s c o
IMb GENERAL PERMIT pprreviouusspermitissued
(NNew VIModification nComplete Reissue ❑Partial Reissue
As authorized by dle�+� SState� of North Carolina, Deparprent or Emeomlenral Qualky and the Coastal Resource; Commkow In an aremimK a of environmental ncem pursto.
I SA NCAC �atn , 1 2,00 C❑++ Rules abachad. [X Germ al Remit Ridesaialhbte at tho folkrwtrrg Uric- H{y,�:s!€st esgav/�'erwn^�
AWIc,,t Nano CIW-K d CYrtS in2 JSA.evtfrter.S Authorized Agestt
Address Atk ceotcLr Reject Location (County): Any_
City mwor . state Z'` c ZIP _2 g . �.� street Addrea State RcaWLot #(S)
PhoneDili-
Emad c(a.+K Sw,yt.rn,p�K Q nn'$�y._Cc m Subdivision ..._
A.I
coy_ w d lap 2�tky4
Affocmd OM M W ®PTA DES ❑pfS Aty. Wtn Body �,�Lzs�i rN.2atS )�'ltex• (r�gerysadt)
AEC(sk [JOEA ❑FHA ❑uw SPIMA ❑PWS Closest plat. Wv: Boil?`ar-k Sei��
ORW: yes, f�d PNA: yes10
of Project/ Activity COAN6,ca- S�lr l ty+/ y` 143, •`(;` Z0. love, -
Type
Lf`23' sht `xZ3' t'x�a+a (Scate:N7$ l
Access Length �• ~�q
P1er(dock)Iength
FNe�dyflatform(4 'tV x2 3
I x2.'S
Floating Piatform(s) e
Finger pler(s)
Total platform area
•
Groin ten0.th/41--.64 -
Bulkhead/Ripnp length —
Avg distance oNnore
Breakwater/sill
Maa"uncellength `^
goat
other
SAV observed: Ws V11
Moratorium: yes no
Site Photos: no
Riparian Waiver AWe cs(9 l_� -
A building permit(zooing permit mW be tecluired by` _-
Permh Conditions ____-.... __
�s.t,.-.-` - .
U TARiPAwNEusE/BUrFER(circle one)
See note on back regarding River Basin rules
See additional notes/comfdions on back
I AM AWARE OF STATUTES, CRC RULES AND CpNDITIDNS DW APPLY TDTHIS PRD)ECt AND REVIEWED COMPUANtE STATEMENT. (Please ln'itial) tE. /23
e— 4^Q.N4 to . gu M to
r ppli`ant PRINTED area
N N 6 /tz/2za
Signature"Pinso read mmprnntt statement on back of R'
Application Feels) Check A/Money Order
�1)7 /n.�
Sign
Issuing Nate Expiration Date

��`°°" ©CAMA ❑ DREDGE & FILL
3 v GENERAL PERMIT
(Previous permit
Date previous permit issued
0 B C D
New Q Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by theSttate of North Carolina, Department of Environmental Qualityand the Coastal Resources Commission in an area of environmental concern pursuant to:
r
15A NCAC 1 i k i;\ m ❑ Rules attached. f"�" General Permit Rules available at the following link: wwwdeo nc gov/CAMArules
Applicant Name
rd
City UE'.\State RL ZIP 21®( 7—
Phone # (i{gs) 2$ I — `�-s`j 1
Email K Umme rS @ 1%'\SK _ C Okrn
Authorized Agent
Project Location (County):
Street Address/St/ate Road/Lot #(s)
lot 12 rll S54
Subdivision
City ler%iur . zip 21k44y
Affected ❑ CW MEW © PTA ❑ ES ❑ PTS Adj. Wtr. Body ` G nNO.hs f2 tjArl+er /(rjnan/unk)
AEC(s): ❑ OEA ❑ IHA ❑ uW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 141 bleAtfl-cXr-k S cs L n J!
ORW: yesco..' yes/ w -A �
Type of Project/ Activity L:ar`a'tTueh- a >
Lf'\c23' seen c-1&.),' I4.t xZ3'
r x Z3� }la
Shoreline Lengthy l J"
Access Length��c
^r VU
Pier (dock) length r x t
Fixed Platform(s) X23 ato d+l'
y` X23' (9'sz3i , N" .ram`
^...du bcsikw�j �` tjc
Floating Platform(s)
Finger pier(s)
Total Platform area rmzl t-
Groin length/H .._
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill '
Max distance/ length
Basin, channel
Cubic yards _
Boat ramp
Boathous Boa[lift Y2
Beach Bulldozing
Other QT
K
SAV
observed: yes Moratorium:
G �
Moratorium: a{ai /ye-s� no
�
Site Photos: grgs+ no j
Riparian Waiver Attached: es (0 �.`� ■
A building permit/zoning permit may be required by:.
Permit Conditions
Agent or Applicant PRINTED Name
W
s
Permit
'411Q
SF fK
r
Nn )
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature **Please read compliance statement on back of permit" Signature '
Iacx�.1)� I'� 6h2/zg I�hZiz3
Application Feels) Check N/Money Order Issuing Date Expiration Date

❑CAMA ❑DREDGE &FILL NU 89787 (A) B C D
Previous permit
I�`°""
I GENERAL PERMIT Date previous permit issued
ONew ❑Modification ❑Complete Reissue []Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. M General Permit Rules available at the following link: wvnvdeg nc yov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Affected ❑CW ❑EW ❑PTA
AEC(s): ❑OEA ❑IHA ❑UW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Project Location (County):
Street Address/State Road/Lot ;
Subdivision
City
❑ ES ❑ PTS Adj. Wtr. Body
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
(Scale:
onoreime Lengui
Access Length I—�
-
--
-
, t
ri-
Pler(dock)length
Fixed Platform(s)
1 1
j -
Floating Platform(s)
_'"
_
_
—f
—
r
_-
(s) ier Finger
g P
r
Total Platform area
-
Groin length/N
BulkhraP length
Avgdistanceoffshore
-
Breakwater/Sill
'.
i
Max distance/length
r
--f--
t—
-
-
Basin, channel
I
--
Cubic yards
_
Boat ramp
I
_
a -
L-
_ `
Boathouse/ Boatlift ��'
I
It
i
� Y.
`4
- -
-
-
Beach Bulldozing
Other
-�—
—
-
SAV observed: yes no
-
Moratorium: n/a yes no
.,
—
L
- -�
Site Photos: yes no
-
—
Riparian Waiver Attached: ves no
- -_-
--
----,-
_-----
A building permit/zoning permit may be required by:
TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
See note on back regarding River Basin rules
See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check Ji/Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT RECEIVED
DJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY 0 C T 1 4 2022
(Top portion to be completed by owner or their agent)
roperty Owner:
Address of Property:
Mailing Address of Owner: c911 Ccct[l�! �� L�mN+Tr NC 0-61 a
Owner's email: dar4ktt"mdrbP&%sn.e&� owner's Phone#: �/o2S-o281 ��o3q�
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
'�Z I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what -is being proposea, you must noury me rr. t,, umsmn ut waacm
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
noted by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must slan
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback Nr /A
Signature of Adjacent Riparian Property Owner
ME
I do not wish to waive the 15' setback requirement (initial the
Signature of Adjacent Riparian Property Owner:
Typed/Printed name ofARPO: Je,AJ i5f^fa
&4-404,
Mailing Address ofARPO: ZJ6( tltZA 55`( Portt i. T l< A/> I�i,='CI,20� 1 C , Z?944
ARPO's email: 53b€ilCc lt-Q Lnttn i c. & n ARPO's Phone#: U,1 - I r Z - .11 6 7
Date: la I It / Z L *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
JACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
party Owner:
a.r /t_ y-
Address of Property: ab ( l^rf
QSsr� T)A i-n+ � �,��-�rd
me
a 9 L/
Mailing Address of Owner: a((
etelowc� 71c1mv-.14
NC -
Owner's emaiI:C/CLfkJttMvnCrSC
fnsn.Corn Owner's Phone#:
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Otvision of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback /
Signature of Adjacent'Riparian Property Owner
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
/-
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: /''%a 7-
Mailing Address of ARPO: '? 77 r a L,, lc 4 d. 14. - � ,UC 2 7 % c/ '�
ARPO's email: !1 R %i`G) e4 , ge eJe , co�i ARPO's Phone#: 2 S 2 - y 3 y- 7e'e2 Z
Date: io - Z �' z�1Z `waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

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