89794A - Halsey

�r' �ICAMA ❑ DREEME & FILL N9 89794 !g a C o
�# GENERAL PERMIT �°ous ;sue,
®New ❑Modification ❑Complete Reissue ❑Partial Reissue
As a rtherized try t6 Saw ofHorth Camino, Depanment of EmEronmarral Qwky And the Coastal Remurces Cornminion In m area a(anvkurxtrenW <orxerrt Punumn to:
ISA NCAC 7-R Uxx ❑Rolm attached. Garcons Pormit Rtrks available atdafoloeit�Etdc mvw.dea.rx.cwKAMArtAcs
pypgSDrt NameV-OSASK
��a n .�Authortzet A&M ••/-�-� -.
Addrab I tt.a is 'i ds w. - `� }�. Protect LOCWN- (Cowry} LGL{dLA.Zii N
Cfv Fri-eeAgrt, state NIC, zip 2,11- Z Street AddronAStata Rw IlLat tt) _1..3.___
etcm,,rt2=-4117'in-4 t -,1, a !� r.
&"At `r4itlibC\S_ e�ro�6ale com s4whibion_ ..ate. PCciitoi`'�f---------
J City t"n(r = hnm zip _ 2l 9 31
Affected ©cw ( Ry (�PDA ❑Es ❑PTs......Adl..w.sedy Al }?2.`Yl��r�e_ ..lotwn.o� akatk)
AEc(s): ❑mA ❑m ❑uw ❑LIMA ❑Pm qmtm vv,,,gody R11xyt�Ar� SQM .
atw: VW/O W&. wwS z
TV" of Proiettl Activity �,Ar,�ce.l� A _... (0 A a I ZI �ncsa�'
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(scale: Ja`.:3Gt )
a.,
Access tergl6
Pier fdodcl k r-`-'r r ' :--{-•-�
--�-�-r- '- '._-t x .-_� -r'-i- x--+--.--
.._ x t
Floatlrrg Paticamis) i--__ r
r
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•^,ems PIHO .__i [ ..L tF.r....�..._
Ester s
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Tout Platform arm
t-1fUkl lerr$IWil h-- � \_� r-; __y i �
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BulkAearYWPaDlength .�-�.___. -r r { . --t r
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x s r s {
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Avg distsrve offshore •' r Y . ,- _; -...e -.- _ 1-_
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{ _. _ -J
Rreakwa[er/5OI
Max distance/ length
�i •_.
-r .y,_
Basin, channel � ' '- x ) i
� r r
Cubtc Yards
Bwtramp
Boathouse • _
- = _ _
Beach Suikbzt '--`-' t
a
Other,
SAV observed: Yes
Motaatorrimn:. t "✓ yes no
Site Photm: no
Riparian Waiver Attached; Be i_..•�L
i
nL� v�_1
A botkRng Permit/inning Parent nwYbe required bf ''t6�68i.Srt 1'1�.T
-!____��. _La� .a-1. .. -. ...__�_. _....�_1
TAWAM44FLW BtJFPER mile one
( )
peonft Conmon,.
❑ See note on back regarding River Bastin rules
.......-_..__....-...._.�_._ _...-__ __.-_.............._._-.--.�.�
See add'Monal notes/condi ions on back
I AM AWARE OF STaUTiS,.CRC RIIRESAND CONVO ONS THAT APPLY TO TNa PROJWI AND REVIEWED COMPUANCE STATEMENC (Please initial) nt At
Agent
signetorer'please re",&mlilience statement on back of pe"Its. SiOtatufp �i .
3160a O-St 339g /sI 1o//5h3
Application Fee(s) Check R/Money CbdEr tswtng Uate Evplrstimi Date

aCOMM, XCAMA ❑ DREDGE & FILL
GENERAL PERMIT
®New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
iN z 89794
Previous permit
Date previous permit issued
B C D
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:
15A NCAC �q (Z� ❑ Rules attached. p` General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name 'CYO Authorized Agent
Address I C),` J.&r i Ae, In' Project Location (County): Ch,)t.a`)` n
City Ea1ev1,1y6rn State Nc ZIP I It -2,L Street
Address/State Rooad/Lot(9#(s) t.k ^4 ( 3
Phone #(=3`1'2- sly; 11� // ���SL"-N�1IckQ Vr,
Email CMS QI-_IC 5!ty Ci YFU O tia'C.0 bra Subdivision Capez (?6(0 t
City Fd� i:m zip 21 e9) 3,
Affected ❑CW ©EW PTA ❑ES ❑PTS Adj. Wtr. Body A' `0-YKa r(Q.. SOicw v. DA (a an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ LW ❑ SPIMA ❑ PAS Closest Maj. Wtr. Body ' 1 I fi�Af- Lt Jt s.. ri
ORW: yes/0 PNA: yesA
Type of Project/ Activity lns't
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
BoathouseAV.atfiftl IZr K IOr
Beach Bulldozing
Other
SAV observed: yes 01
Moratorium: <n a n yes no r
Site Photos: no"\ I • s �z
Riparian Waiver Attached: a no {{��
A building permit/zoning permit may be required by: Cr OWOLVv COin Nill
Permit Conditions
(
(Scale: If
--
AN
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Naine Permit OfficM' PRINTED Name
0 IF- 14
Signature -'Please read compliance statement on back of permit"
,Ia&,) . a� 33y 3
Application Feels) Check #/Money Order
Signatur �I
�d-,S�Zi to/1
Issuing Date Expiration Date

FICAIMA ❑ DREDGE & FILL ti NU 89794 ia" B C D
Previous permit
a I GENERAL PERMIT Date previous permit issued
0 New ❑ 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:
15A NCAC ❑ Rules attached. - General Permit Rules available at the following link: w.wvdeg.nc goy/CAMArules
Applicant Name
Address
City State
Phone # ( )
Email
Affected ❑ CW - ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no:,
Type of Project/ Activity
Shoreline Length
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
'- -, 1'
(Scale: )
Access Length-
Pier (dock) length
Fixed Platforms)_
1
r+.—
-
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/It
JINN
—J__
1
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill
I
—
Max distance/ length
Basin, channel
Cubic yards'..
Boat ramp
Boathouse/ Boatlitt
Beach Bulldozing
Other
i
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—'
i
.J
_
-
r
I
J—
i
i
(.
/l+i..
Zz—
I
I
JP—
.i.....
iI
SAV observed: yes"—
Moratorium:.- n/a yes no
Site Photos: "hex no
Rioarian Waiver Attached--'Vds no
1
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A building permit/zoning permit may be required
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ 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"
Application Feels) Check q/Money Order
Signature
Issuing Date
Expiration Date

%i pQJC Lif�r 6r'.1
ere' t' "1 51 (,
N.C. DIVISION OF COASTAL MANAGEMENT a
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORMA
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent}
Name of Property Owner: L %a' � 0— P el /SSiq 1 i a lyre
Address of Property:
Mailing Address of Owner:
N/
73 Z
ti
Owner's email: Cr'w;j.ha :P � fe' `riser's Phone#: f I
Agent's Name: Agent Phone#:
Agent's Email:
J U N 0 5 2023
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION �` j o'w 6
C (Bottom portion to be completed by the Adjacent Property Owner)
i hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions must be provided with this letter.
C, i DO NOT have objections to this proposal. I DO have objections to this proposal.
n you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be
mailed to 40f S. Gin St, Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 264-390i. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose oniv one
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 daes not apply to bulkheatls or dprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive sometali of the 15' setback
d -OR-
�A jacdj
Sr afore oent Riparian Priobrity Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: r/ 1 Z,
Mailing Address of ARPO: 1 U u
ARPO'semaD: o �s« 1
kTr �.✓ _.s,r,; �-. � � s .a � `��t fS's Phone#: ro, s' � 3 3
Date: _ (r r' - _"waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

kit Bball)WdN
Frce /P)4,i s i d (
N.C. DIVISION OF COASTAL, MANAGEMENT 0
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM °
(Top portion to be completed by owner or
Name of Property Owner:
Address of Property: I /'k , pt/ /-_ 2: U y
Mailing Address of Owner: ! /o yl w
Owner's email: Gfeuy,h r�� (t'dic pdd;lpOwnarsPhone#:
Agent's Name:
agent) freer( Ct4th �`"d�
:,t ✓ j J
/t)C , /,F'T Z.
� ECO.FIIV' ED
Agent Phone#: iUN 0 5 2023
Agent's Email: y q �ddtGiVd Ep
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION t_,rC
(110112m portion to be completed by the Adjacent 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
description or drawing, with dimensions, must be provided with this letter.
Y' 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. Division 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 /s considered the same as no objection If you have been
notif ed by Certif/ed Mail.
WAIVER SECTION {Choose oniv one
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 A jacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:7�+{a,rnt+
Typed/Printed name of ARPO:
Mailing Address of ARPO: ­P• O �� 1r / P.c.
ARPO's small: 1' aeerrp%iQ &k&d04
C•r°ARPO's Phone#: o C2.-333.94%
Dater 4 !91�&i ( ZO a3 'waiver is valid for up to one year from ARPO's Signature`
Revised August 2022

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