89935A - Hare

OCAU74, ❑CAMA ❑ DREDGE & FILL Nv 89935 A B C D
Previous permit
0 H GENERAL PERMIT Date previous permit issued
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. 0 General Permit Rules available at the following link: wwwdeq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
State ZIP
Affected ❑CW ❑/R EW ❑PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
ORW: yes/no' PNA: yes/r(o-)
Type of Project/ Activity
Project Location (County):
Street Address/State Road/Lot #(s)
City
❑ ES ❑ PTS Adj. Wtr. Body
❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
Shoreline Length
Access Length
Pier dock) length
Fixed Platform(s)
—
I—
—
Floating Platform(s)
31
Finger pier(s)
Total Platform area
Groin length/a
_�J-4
Bulkhead/Riprap lengthAvg
distance offshoreBreakwater/SillMaxdistance/length
�""`_i""_I-
Basin, channelCubicyards
I
;
Boat ram
Boathouse/ eoatlift
"""
'
u'i"Beach
BulldozingOther
-
1-
SAVobserved: yes no
'
I—
I
_
I77
Moratorium:. - n/a yes no
Photos: no
t
-
y
1
-
---Site
�.
yes
1.':
Rioarian Waiver Attached: yes no
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A building permit/zoning permit may be required by: °" ,Cd v. ` -
❑ 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 M/Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top Iportion to be completed by owner or their agent)
Name of Property Owner: Dow I U `� yc,
Address of Property:
Mailing Address of Owner: �j
Owner's email:rj&Wq hQ/C,I9 �iP)6tr I•C(,Yf1OWner's Phone#: Jga- 333 • l3�,
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(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 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.
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 is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose only 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 rigrao 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
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO: =
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature`
JUL Ill 1.0t'i
®ur
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Do-y % d J Haire
Address of Property:
Mailing Address of Owner:
owner's emaidolU q,ha 19B5inAII wi 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 forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
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.G. urwsron or coasrar
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 (Choose only 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 Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Rt...
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO: IL (A 4} �{• �rbio,4.7
Mailing Address of ARPO: ,jl`1 W�7u1 �S,�i Imo✓= sic. % K"- �1/��
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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