89904A - Key

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"t°"Z4®CAMA ❑ DREDGE & FILL N9 89904 (D B C D
GENERAL PERMIT Date Previous
Date previous permit issued
❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by die Statte of North Carolina, Department of Environmenta) Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ryN' (10o ❑ Rules attached. ® General Ppmit Rules available at the following link: .tLSEo /CAMArules
Applicant
City EliZ4loa� 42-is4 State Ne- ZJP a7904
Phone #('tom) 31t)�--"tit (�
Email �Ck.kkVf VkF-9Lj @ CFtpre()
Authorized Agent �} Project Location (County): [�e14 5U a"kC
Street Address/Staw Road/Lot #(a) 6� '
j31 i eeAiocL. j�ainl i7r,
Subdivision 16,1 Cck N
City EliZ4lOeAk i.'}4 ZIP a-?WR
Affected ❑eW tZEW RPTA ❑FS ❑pTS Adj. Wm. Body collml y� (naU(a/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body ���L4A f C, A.IC ILf Ve,
ORW: yaskw—) PNA: yes/
type of Project/ Activity L6t5S'�Yt.11
I'K zr�'
. aer
Shoreline
Access Length [' 'K�t (�=
Pier(dock)length
Fixed Platformis) X GCS
Floating Platfurm(s)
Finger piers) r X20
Total Platform area
Groin length/#
Bulkhead/Riprap length
Avg distance offshore ---
Breakwater/Sill-
Max distance/ length
Basin, channel _ -
--
Cublcyardsj-
Other
SAV observed: yes i at
Moratorium: yes, no -
Site Photos: lyeD' no----%
Riparian Waiver Attached: yes Llffb ,._:...
A building permit/zoning permit may be required
Name
,xl
I
------------
Permit OffMr'j PRINTED Name
I
❑ TAR/PAM/NEUSFJBUFFER(clrcle ono)
See note on back regarding River Basin rules
See additional notes/conditions on back
(Please Initial)
Signa re••PleaCS.
se readcompliance statement an back of permit•' ` SlgnRs� lO/
,52M. � i �1(0/2 3 A6 623
Application Fee(sl Check N/Money Order issuing Date Expiration Date

�CAMA ❑ DREDGE & FILL
.GENERAL PERMIT
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N9 89904 ��_ 0 B C D
Previous permit
Date previous permit issued
As authorized by the StateofNorth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC 114. (2 oz) [-]Rules attached. 10 General Permit Rules available at the following link: wwwden nc Pov/CAMArules
Applicant Name {—CL U re _h
Address 11 00
City EtiZ4\bQAN Ci:a jjState r\ie zip 27ci05
#(� Phone) 1(.2�,�,LZ,,.2 (7
Email 10.vlhP A L04, @ S)LtO.Ys' (GYP- Y1'Vi2V"fMCLnCL' t
Authorized Agent ( �
Project Location (County): JPCO 4 LAobCl.h k
Street Address/State Road/Lot#(s) 14A1
Subdivision oc2Vx A(3 K p
City E(tzct102 . iitj ZIP al ola 1
Affected ❑CW QEW IePTA ❑ES ❑PTS Adj. Wtr. Body ColV o,I j r7 (nat/®/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ?QS E ti Y Q & ILI V Fn^
ORW: yes, IV PNA: yes/(oO
Type of Project/
Li IX 9Mr
Shoreline Length 'I—IU`1
Access Length �^
X
Pier (dock) length
X
Fixed Platform(s)
rm(s)
Floating Platform(s)
Finger pier(s) L4 ' K 20'
Total Platform area 5 a
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
oathou e/ Boatlift f K (lt
Be Ildozing
Other
Ccar.a l
SAV observed: yes �u` "_,() 7
Moratorium: Kes� no
Site Photos: IyED' no
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by: Permit Conditions(.') �'� ter A,c ­� o(1 T ri:
OF STATUTES. CRC RULES AND
Agent or Applicant PRINTED Name
(Scale:l'rc'5d )
N
�O
` �2
� w�
S
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Permit Oftrt PRINTED Name
Signature **Please read compliance statement on back of permit**
152M.C&L l
Application Feels) Check #/Money Order
Sign'(;( t 0//6 1.C3
Issuing Date Expiration Date

�° °"'" ❑CAMA ❑ DREDGE & FILL N� $99�4 I Aj B C ; D
a� Previous permit '
GENERAL PERMIT Date previous permit issued
FNew ❑ 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. ❑ General Permit Rules available at the following link: www den nc gov/CAMArules
Applicant Name
Address
City - State
Phone#(_)
Email
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑OEA ❑IHA ❑UW
ORW:yes/no PNA: yes/no
Type of Project/ Activity
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
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
ZIP
❑ ES ❑ PTS
❑SPIMA ❑PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Win Body (nat/man/unk)
Closest Mal. Win Body
(Scale:'
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
1 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 Fee(s) Check #/Money Order
Signature
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to L.acy^t%-<- hz� 's
Y(Name of Property Owner)
property located at /31 -Pi(; C41I
/^g �i tnuwebs,.wl, OLVUK' mvau etc./
on _ l �y. t'L 4 czf- ! A d:L = n �C — t _ N.C.
(Waterbody) (City/Town and/or Co
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description below or attach a site drawing)
REC
J U N 0 5 2023
DCM-Ev--C
WAIVER SECTION
1 understand that a 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.. (If you wish to waive the setback, you must initial the appropriate blank below.)
_ _ I d ish to waive the 1.5' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
,Cam Kee, -
Print or Type Name
1100 Meadow Drive
Mailing Address
Elizabeth City, NC 27909
cilylslam'Zp ----
252-312-5922 [e-mail]
Telephone Number!email address
9/16/22
Dwe
'Valid for one calendar year after signature'
Date*
(Revised Aug. 2014)
-1�%)q

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ol 6iAeet') ,s'
n (Name of Pro erty Owner)
property located at I S 1 tii ca?0~'yir F wrz bulg Ci+a. NG
(Address,. Lot, Block, Road, etc.
on Cc,nat d? Foall ,,HnM- , in 2 e-pli nild. N.C. -.
(Waterba y) (CitylTown nd/or County)
The applicant has described to me, as shown below, the development proposed at the above'',
to n.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attacha site drawing)'
j U N 0 5 2023
s`a ,b
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
Date
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner Information)
Number
"Valid for one calendar year after signature'
(Revised Aug. 2014)

J U N 0 5 2023
QCM-C

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