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GENERAL PERMIT
® New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
LV70PiUP
L,
Previous ermit
Date previous permit issued
\aJ
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 rl N , (aM ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc gov/CAMArules
Applicant Name 1 , `
ne.
CWt 5
Authorized Agent
Address (O
C,
a15t i A
oke— 'On
Project Location (County): e4 C Y\$
City qqA-_L,
states
RC zip a)
Street Address/State Road/Lot #(s) lesy *122,
Phone # (au O��o'L'(
"� �S.J
p
I t o
Email
pS�U�I��
Subdivision W,%�6 ky o
�j
City N 'T'6'r-� ZIP a7y4N
Affected ❑ CW
NEW
N PTA ❑ ES ❑ PTs
Adj. Wtr. Body A Ooeamk-cke-
a nanlunk)
AEC(s): ❑OEA
❑IHA
❑UW ❑SPIMA ❑PWS
1 CC
Closest Maj. Wen Body NtVCA-Y�Q k �6,rJ
ORW: yes/0 PNA: yesoo
Type of Project/ Activity Tn a lk 0. ) br c i Z I 6.�l, A
(Scale:) �r )
Shoreline Length
Access Length '^
Pier (dock) length _
Fixed Platform(s) _
Floating Platform(s) r
Finger pier(s)
Total Platform area
Groin length/q
Bulkhead/ Riprap length
Avg distance offshore .._
Max distance/length
Basin, channel
Cubic yards,�?�
Boat ramp / a
Boathous oatli01K1Z.f 7y'. tL hjWt
Beach Bulldozing '�-
Other
�r4\
SAV observed: yes
Moratorium: yes no
Site Photos: ye no
Riparian Waiver Attached: es no
A building permit/zoning permit may be required by: kr z7t Ok W�V cok& t.
❑ 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)
n °a
Agent or Applicant PRINTED Name Permit O ggr's RID Name
Signature "Please read compliance statement on back of permit** Sign tyr l r 5 1
ace. jaY %3,z� 10/131Z
Application Feels) Check M/Money Order Issuing Date Expiration Date

❑LAMA ❑ DREDGE & FILL NY 89769 A B C D
Previous permit
G E N E RAL 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 I (l. I " ` 'u ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeq nc gov/CANIArules
Applicant Name i t f I I i+, `. i� l r--` -'j Authorized Agent
Address Project Location (County): { 'h G n `1
City State +'�l, i. ZIP I'i _.I.,I Street Address/State Road/Lot #(s)
Phone#(
Email - "` Subdivision
City ZIP
Affected ❑ CW EIEW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtn Body `
ORIN: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:• )
Access Length �._.—.
_
I.
r.
-
1,4
Pier (dock) length
Fixed Platform(s)
({
_
Floating Plafform(s)
Finger pier(s)
Total Platform area
Groin len h/#
Bulkhead/tRi rap length
i
I
r;
�
F
r
-
_--
Avg distance offshore -
Breakwater/Sill
Max distance length
Basin, channel
Cubicyards
Boat ram
Boathous0oatlift i /C`
I—
-
-
-i-
i,
"�-
1
°�-
-.r
-
�—
-
�-
-
--
-
-
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--
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t
j
f
;_
I
t
T
I
_
-
1
_
._
-_
!
_
_.
t
)
rat
Beach Bulldozing
Other
I I
r
IT
SAV observed: yes no i
n/a yes no
I
SiterPhotos: no
Pins a Ul.hm ntt.,hcd
A building permit/zoning permit may be required by:
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" Signature
Application Feels) Check #/M1 oney Order Issuing Date Expiration Date

RkECENED
N.C. DIVISION OF COASTAL MANAGEMENT
MAY 3 0 2023 ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
GERTIFIED MAIL RETURN RECEIPT R nl IFSTED Or HAND DFI (VERYr
D1 V i[ \✓ _C (Top portion to be Completed by owner or their agent) r°
1 Name of Property Owner: d Z4 Ai, d f?
Address of Property: /� --J__-- J.' , ii/
Mailing Address of Owner: Y-6-/i'c`,� / Y
Owner's email: fV/111 Owner's Phone* Z - ;Z& el
Agent's Name: r�
_ ^ cl / : "G� Agent Phone#`: y
Agent's Email:
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
pemut 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.
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 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
notfed 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 waive the setback, you must sign
the appropriate blank below.)some/all 9
I DO wish to waive some/all of the 15' setback a of ent Rip rian Pro
-OR-
perty Owner
t DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
TypediPtinted name of ARPO: _ �y C C e t ir�Y) K-r-1 %. t--(%
Mailing Address of ARPO: O o L
ARPO's ORPO's Phone*:
Date: , % 23 -waiver is valid for up to one year from ARPO's Signature`

N.C. Dmism OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIfICATIONMAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DEUVERY
(Top portion to be corn;Aeted by owner or their agent) �011/ MAY 3 0 2023
NO" Of prop" Omw 2) ;r A / 4
A
AMWS at PrOPerif /Y
MailingAddrefto(Omw, A) C—
OVx"r13 errat 2—OwneesPhone#-.
Agents Name: Jp�-/ A -'Al, Agent
Agents Eq*k 11 4-,OZ79
11 SYR 0 ROL.- RJANUMiO W*001!�Y ,
i remby car* fig I am prop" a6famst to ft above referenced prop". The wKgvKkW am" for this
paink has desCribml to M as sham an the aftched drawing, the deve;0Pffm"t they are PrOPOSHng. 6
ftcrfan or drawn, with dirnensions, must be provided with this letter-
9 YOU 012W 0kVCV0nS to what is bebw proposed you Must notify the N.C. Division of Coastal
Aganagimmn (DC" in wrRing, wigrin 10 days of receipt of this notice. correspondence should be
mailed to 401 S. Gm'rm St:, -qt& 304 EMmbeffi QW, NC, 279M DCH represenrUbves can also be
C00009d at rM4 264-3901. No response is considered We same as no objectfon if you have been
notified by CerIffied Umil
WAIVER SECTION (Choose oniv one
I Undmtx1d VW any peimmi pier. dock. moming PkW, boat rarnp. breAwalw. boathouse. lift, or
grain n be set back a rninirmm clislarxe of IS from my area Of fil"m access UrdesS waived by me
aDm does no(VW to bulictmads of naras) revetrrw-� W" must Sion
theaPPDpr&*e black below.) /
I DO wish io waive sorrWal of the 115'setback 71/7a771--f - /
mm
I DO NOT Wish ID Waive the 15! setba& reqmmefo Cffutial the blank)
SignaMm of Adjacw* Rkuslan PmW OV
TYPOM""d FINIM of ARPO-
UrAing Address of ARPO-.
ARPO'swawk
D31W
Revised Awymt 2022

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