89914A - Harrell

fir° N cAMA [IDREDGE & FILL �� No 89914 A B c
Previous permit
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:
I SA NCAC ❑ Rules attached. [Z General Permit Rules available at the following link: wwwdeq.nc gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # (_ )
Email
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
(Scale: )
_...._..._
Access Length1-
i.n.
I
_,_
1
...
-r
Pier (dock)length
i
Fixed Platform(s)
r r
f
f
�
_
!'
)
_
—
Floating Platforms) --
�
IT
'
Finger pier(s)
T
Total Platform area
.h
--
—
---
---
1
--'
Groin length/#
Bulkhead/Riprap length
Avg distance
--
—
{
--
r
_
offshore
i
Breakwater/Sill
Max distance/ length
Basin, channel
t
.C�l,
�`
7�
yards
�
Boat ramp
Boathouse/ Boatlik
Beach Bulldozing
Other
i
I
SAV observed: yes no
Moratorium: n/a yes no
L
l
T'
i
t
—
I
'
- --'
r
z
-^
_
•' e77
H
Site Photos: yes no
,
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1
I
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Rinarian Waiver Attached: ves no.-
r
A building permit/zoning permit may be required by::1.
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) r
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature**Please read compliance statement on backof permit'* Signature
Application Feels) Check#/Money Order Issuing Date Expiration Date

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: VY / rr rccr r Ii/ • t fell a y r r C Vl 1 AL 7 1.
Address of Property:
Mailing AddressofOwner: �L� Q iz✓e_ r r�i4
Owner's email/J/��k/YL9a*02Ai9?7Aner's Phone#: �otJroi �6'��6
Agent's Narne:
Agent's Email
cvf3 /2- D O
Agent Phone#: � �•�
e -C,s I Vgq� D
2 g 2023
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
1 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, urvrsron or coasrar
Management (DCA1) 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 riprao 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 E�
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 Owner:,^_)ti-/Pa & 0
Typed/Printed name of
Mailing Address of ARI
ARPO's emaiL�� �?�7 uo `��5^� ° �ARPO's Phone#:�S 1 ' j�S' /���3
Date: /I3 _"waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

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:
Address of Property: r'
%.
Mailing Address of Owner: �Off�L/l.GflL DhM74,&i-d,X1. 6
Owner's email/a /�ner's Phone#: pt.SA
Agent's Name:
Agent's Email:
Agent Phone#:
rrl//
JUN g 0'l3
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner) q
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.
V_L_L 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. vivision or c:oasrar
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 Mall.
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 v n w
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 Owner: t U I i' irw1-
I,l
Typed/Printed name of ARPO: ,1 ) i rhwt � (`cf w\ c I S
Mailing Address of ARPO: / / (0 t-t G p l' 17 hari r /1K P 1 'Yc�''C4 r V t--'
ARPO's email: �Ii f Fruh� S��zctr?e ARPO's Phone#: -f5-7`7 2'l'-bl s3
Date: G L/"waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

LOCATION MAP (N.T.S.) I 4 — - - -
GRAPE= SCALE
�y N23'04's
EDGE WATER
�LOT 3
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I STORY
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FOUNT
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45.99' j
�— S34°45'00"E
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aT
YEOPIM RIVER
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OF BANK (12/02/10)
LOT 4
ro
< y1,6p,
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`eonnce�oe>aee
CAP B�Om
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LEGEND
SEAL
PIN (F)
1
®PIPE
(F)
=C L-3531
�
POWER POLE
WATER METER
�D�➢eoeeae�V®e
CALC POINT
1, GLORIA J. ROGERS, P.L.S., CERTIFY THAT THIS
MAP WAS DRAWN UNDER MY SUPERVISION FROM
AN ACTUAL SURVEY MADE UNDER MY SUPERVISI,
THAT THE BOUNDARIES NOT ACTUALLY SURVM
ARE SHOWN AS BROKEN LINES PLOTTED FROM
INFORMATION FOUND IN E%ISTING RECORDS AND
THAT THIS IAAP MEETS THE REQOIREMNTS OF
NCAC TITLE 21. CHAPTER 56, SECTION .1600 AS
AMENDED. NTTNESS MY HAND AND SEAL THIS
THE 2nd DAY OF DEC 2010.
�'J/V�-
60,
LOT 5
m
r r e'
�;. ,� RICH ,
J U N 2 9 2023
D C,c f\d i — "i,..,
Leo
2p\
LOT 6
BENNIE L. WILLIAMS, JR.
D—o73 LOTS 3 AND 4
' BETHEL FISHING CENTER
JR PERQUIMANS CO. I BETHEL TOWNSHIP I NORTH CAROUNA
L'S. // / ' L-3531
GLORIA J. ROGERS � N.Cp�27921
PROFESSIONAL LAND SURVEYOR T(aaz) 333-8781 ��

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