89960A - Craven

❑CAMA ElDREDGE & FILL �(� N° 89960 Aj B C
GENERAL PERMIT Previous permit
Date previous permit issued
BF-INew ❑ 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, r General Permit Rules available at the following link: wwwdea.nc goy/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
ZIP I t
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no.. PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger
Total Platform area
Groin length/N
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 I
Moratorium: n/a yes no r >,
Site Photos: yes no I
Riparian Waiver Attached: yes no .L.
A building permit/zoning permit may be required by:
Permit Conditions
(Scale: )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
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
(ot-10 1
Application Feels) Check q/Money Order Issuing Date Expiration Date

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■ Complete items 1, 2, and 3. IFA■ Prigqt,your name and address on the reverse4q.that we can return the card to you.■ Attabh3his card to the back of the mailpiece,
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PS Form 3811, July 2015 PSN 7530-02-000-90W
❑ Agent
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❑ flegistered Mail Restricted
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❑ Signature Canfirmatlon"
MctedDelivery ResMcted Delivery

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: se4k nrot, ✓ev.
r
Address of Property: 3 0 -irA I''I N- 0 2 C 4y %� G a rZ clnn//
Mailing Address of Owner: i9G% hill JC' 6, � hS htJ%
D/ ✓.1L ri 4
Owners email: r114 Owner's Phone#: G1L� �(r 110)(3
Agent's Name:
Agent's
Agent Phone#: -33 I - 4313
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
✓ 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.G. urwsron or wdadl
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' setba`�
Signature of Adjacent R anan Pro Owner
-OR- ..,,.
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
TypediPrinted 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'
P^' d box a'5 a r
2, C4,1 nc- 01r7 Clv[o
JUN 2 7 W3
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Revised July 2021

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