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GENERA fr "Banff Previous permit -_--
GIIF'-+11� lr" V Date previous permit issued
New [:]Modification []Complete Reissue ❑ Partial Reissue
As authorized by the
��theState of
North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmedtal concern pursuant to:
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15A NCAC �( . a4 I( '. ❑ Rules attached. ;74 General Permit Rules avallable at the following link: www.dee.nc.govlCAMAmfes
Applicarx Name_J=J2_ bfA' IJAiA=V{a,lt i-!_1siF-•-
Address I�._y� (-IE 1
44
City Stare _j1i�"_ ZIP��_`'f
Phone # l!% Zfl W_ 1!Z S --
Email wdd_ �r?ale "L CC DA6.,
Affected ❑CW �&W KPTA
AEC(s): ❑OEA ❑IHA ❑UW
ORW: yes no PNA: ye ho'
Type of Project/ Activity
Access Length '•�
le dock)length 4'OIK (oI
Flied Platforms)
Floating Platformis)
Finger pier(s)
Total Platform area
Groin length/fl
Bulkhead/ Riprap length _
Avg distance offshore
Max distance/ lengt
Basin, channel _
Cubic yards _
Boat ramp _
Boathouse/ BoatliR
Beach Bulldozing _
Other
SAV observed:
Moratorium: (aj
Site Photos:
Riparian Waiver Attached:
A building permit/zoning I
yes \V5�)
yes no
0,; no
6 no
li may be required
IA,
❑ES ❑PTS
❑SPIMA ❑PWS
p
Authorized Agent)gLsj--W&- L/v-I:Ae)i:4'1�.L�Li,_
Project Location (County): ,A
Street Addi ess/State Road/Lot#(s))� !_( „yz i% 1=i� L•�—
Subdivision.._—i.CLi.}11.(41.4 Fe_C�I`�:t
City _i L=1..�.1'1+t:'Yl 1__.—_ ZIPt-t-( c•b:
Adj. Win Body
Closest Maj. Wm. Body
i
.ts k
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Agent or Applicant PRINT" me
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sig(nnat/�iv "('Pleasereead compliance statement on back of Permit-'
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"�\!.1. (�,L 1. V 04'/
Application Feels) Check H/Money Order
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j
(Scale:
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�W,um)1
❑ TAR/PAM/NEUSE/BUFFER (circle one)
ElSee note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
PRINTED
to E,pi. anon Date

WAMA ❑ DREDGE & FILL N° 89799 (L L d B C D
GENERAL PERMIT Previous permit
Date previous permit issued
$New El 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 'T H • 1 2-0L% ❑ Rules attached. 'Vq General Permit Rules avvailable at the following link: www.deq.nc.gov/CAMArules
Applicant NamenPOWNf 4 4 Pay— Authorized Agent l�bV ,iAd jm (-OYI5i-y1. dio K,
Address t�I UZ L (C1. W+- Project Location (County): / AG�.Y�s1.4
City IL.D I"� State 1�9C ZIP T ) StreetAddress/State Road/L�ott#(sf02 A ,," �Vt.�
Phone # (� iff to — 217 S QCJ. LA V f . LQ - tt 1 3CL'A ula. /3
Email btay+poLV- Ln 0.0L.C1]by`. Subdivision co Lt
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City ZIP 2414 P)
Affected ❑ CW J>kW PTA ❑ ES ❑ PTS Adj. Wtr. Body na an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes no PNA: ye no
Type of Project/ Activity
Access Length
ie dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area _
Groin length/N _
Bulkhead/ Riprap Jeri
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift _
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zoning r
Permit Conditions I�J�
AWARE OF
yes ©°
yes no
Rsves no
I'lit may be required
✓`
1/
FTT
11LL AI.
RULES AND CONDITIONS THAT APPLY TO
Agent or Applicant PRINTED Name
(Scale: N75)
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r
«r�
II�IMIMA
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PL
ti v �1 re, p ~
TAR/PAM/NEUSE/BUFFER(circle one)
?fityys ❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
PRINTED
(Please Initial)
Signature --Please read compliance statement on back of permit" Signatt
V Zoo, tDc ( ac hy10w2 I
Application Feels) Check q/Money Order Issuing
Date

❑DREDGE & FILL NU 89799 A B C D
GENERAL Previous permit
PERMIT
� Date previous permit issued
i 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 {- 4.. `' %+ ❑ Rules attached. � General Permit Rules available at the following link: wwwc1eq.nc.gov/CAMArules
Applicant Name (fF--
Address !: ,�,. ♦4 ,A.
City State NQ zip .1 J f-f
Phone#(4d ) flk..^ )11-1:7
Email V/Y.V 4—hi-'. 1. (i..,, G- a.ol. . C PV'-'.
Authorized Agent fl
v ; 71 lE f `' i(4.4/i VI/ l tt`J9 4rV fh,
Project Location (County): �l�Lt,tr+�. �,..
Street Address/State Road/Lot #(462 t r i s! a P B I^y l G)s'�,f4
Subdivision
City J
Affected ❑ CW EZ.FtW !J PTA ❑ ES ❑ PTS Adj. Wtr. Body rN
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PINS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: NT?a )
::
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yi.AfA
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Total Platform area
Groin length/#
BreAvg akwater/Sill
Max distance/ length
Basin, channel
BeachOther:ME
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in
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Site Photos: es no
Riparian Waiver Attached: yes no
I AM AWARE OF
Agent or Applicant PRINTED Name
AND
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
STATEMENT. (Please Initial)
PRINTED Name
Signature **Please read compliance statement on back of permit** Signature, i 7
14
Application Fee(s) Check q/Money Order IssuinTExpilraition Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Robert 1. Polk and Cynthia G. Polk
Mailing Address: 102 Queen Mary Ct., Colington Harbour S/D
Kill Devil Hills, NC 27946
Phone Number: [phone]
Emaii Address: [e-mail]
I certify that I have authorized Jason W. Wall of Able Marine Construction, LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: Repairs to Dock: Remove existing dock;
use existing pilings and rebuild dock.
at my property located at 102 Queen Mary CT, Colington Harbour SID, Kill Devil Hills, NC 27M
in Dare County.
I furthermore certify that / am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property wner Information: n s
a4le�
signature
Robert 1. Polk and Cynthia Polk
Print or Type Name r�
Property Owners Ro bee,T a- l...I n j h 9d oe-
Titre
Date
This certification is valid through I t
1UN 2 1 '111B
DCM-EC

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Robert I Polk & Cynthia G. Polk
Address of Property:
102 Queen Mary Ct., Colington Harbour S/D, Kill Devil Hills, NC 27948
Mailing Address of Owner: 102 Queen Mary Ct., Colington Harbour S/D, Kill Devil Hills, NC 27948
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Jason W. wall or Able Marine construction, LLc Agent Phone#: [phone]
Agent's Email: [e-mail]
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.
�h)(j AJZ_ 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
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 scan
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent R rig rQp� y Own r
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Kenneth B. C
Mailing Address of ARPO:
ARPO's email: 124 re
and Sonya M.
ARPO's Phone#: _7 %L/"
Date: (nT,3i 1401'waiver is valid for up to one year from ARPO's Signature`
104 Queen Mary Ct, Colington NC 27948 R
EC° °;/(F D Revised July 2021
j U N 2 3 2023
DI C N4._

■ Complete Items 1, 2, and 3.
■ print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front If space permits.
1. Article Address d to' y�
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9590 9402 6011 0069 6694 66
7016 0910 0000 6154 71.1=r
pS Form 3811, July 2015 PSN 7530-02-000-9053
If YES, enter delivery address below: p No
Delivery nervrn nd17 "
Merchandise
doted Detivery 619,w1conremation-
0 Signature Z,,Ir. etlon
Delivery R"bWted Delivery
Domestic Return Receipt
J U N 2 3 2023
®VIV —EC

■ core .Items lr'2 lw1 3.
• name and address on the reverse
e can return the Card to you.
• his card to the back of the'inailpiece,
or on the front If Tap permits.
1. Aredda Mdressed to:
sw4 '4"wu-m Sr► RAwt
(3�t_iFlj �fAR1� a �w1U
IIIIIII�illl18111111111111111 IIIIIIIII III
9590 9402 3871 8060 8575 95
7016 0910 0000 6154 9010
PS form 3811, July 2015 PSN 7530-02-00049063
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JUN23113

AT I -TACHMENT TO LAMA ARPO NOTIFICATIONAVAIVER. FORM FOR THE ROBERT
ANDCYNTIIIA PROJECT
RECCIVED
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104 Queen Mary
CT - Gregory
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ATTACHMENT TO CAMA NOTIFICATION/WAIVER FORM
ABLE MARINE CONSTRUCTION LLC
101 Airstrip Road, #390
Kill Devil Hills NC 27948
Email: obxdreamworks(a'yahoo.com
Telephone: [phone]
TO: Robert I. Polk & Cynthia G. Polk
102 Queen Mary Court
Kill Devil Hills, NC 27948
Email: bertpolkldaol.com
Telephone: [phone]
JOB DESCRIPTION OF PROPOSED WORK
Date: April 22, 2023
JOB SITE: 102 Queen Mary Court
AKA Lot 7, Section O 1 U N 2 1 2023
Colington Harbour S/D
JOB DESCRIPTION TO RE -BUILD DOCK USING EXISTING PILINGS
Repairs to be made to existing 240 SF dock as follows:
®CI -EC
- Existing dock to be removed by Client except for the existing pilings which will remain.
- Client to remove all debris related to the dock removal from job site.
- Install new 4" x 8" 2.5# marine grade girders and joists. Joists to be set on 16".
- Install (2) 5/8" galvanized timber bolts at all piling to girder and at all outer joist to girder points of
contact.
- Install (1) 5/8" galvanized timber bolt at joist to girder point of contact.
- Install Thru-flow decking using 3" pan head stainless steel screws.
- A final site clean-up of related debris due to Able Marine Construction's work to be performed.
This is an ESTIMATE ONLY based on our evaluation of the work. It is not a Contract. This Estimate is to complete the
job as described and set forth above. It does not include any changes that Clients may make during the project or for any
additional labor which may be required if we run into problems during construction of this project. The above price does
not include any additional work of any kind. PLEASE NOTE: Due to the volatile building materials market and escalating
pricing, lumber suppliers are only holding or honoring their quoted prices for 14 days. If you decide to do this work, I
would ask you to notify me ASAP. Prior to the start of work, I will have my supplier re -quote the materials to see if there
has been an increase in pricing and then notify you if there has been. PLEASE CALL ME with any questions concerning
this. Upon Clients' acceptance of this Estimate a Contract will be drawn up and signed by both parties.

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