89933A - Slater

❑CAMA ❑ DREDGE & FILL N° 8903 A B C
a Previous permit NV
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 /,� y I 1 ' ❑ Rules attached. 0 General Permit Rules available at the following link: wwwdea nc.gov/CAMAmIes
Applicant Name �. 7 f to J._ i' 4
Address r? i. F:, '„ 0 d e,J 1%:a A LS)
CityState `ay%`c ZIP-L.a,i-1 <.'✓
Phone#('('�":) �..��., 1.�,?)t-; !
Email Wj s��f'' G 4) f�. f V e: I.: P l" :+ W1
Affected ❑CW11 EW ;n;'PTAES �PTS
AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA ❑PWS
ORW: yes/no). PNA: yesf o,,)
Type of Project/ Activity I ,:fL
Shoreline Length z,..i`>ti
i,
Authorized Agent d"ti N r3 r ��, h) , Y l �.�11•Yfs_C o'I `�3 c: C l i
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Project Location (County): s, / f {- 1 Y { J C- V-
Street Address/State Road/Lot #(s) ').1? t '7
Subdivision �f' Ir (, \1 ei
City C oy'r'i ( ( : i_ ZIP 2--J
Adj. WCr. Body Can ay�i "'Y"!; �+. t�s n'd(` .�5\ .�>'fi.(nat/fnan/unk)
Closest Maj. Wtr. Body : t try) , t r .1, ^I , 'l> ") I I V i i
(Scale:t'- ';:/;?r)
r
Access Length
Pier (dock) length�'-
Fixed Platform(s) T
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L-
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F
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-
Floating Platform(s)
•
Finger pier(s)
fd�
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t.
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L
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S AT
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Total Platform area
Groin length/#
Bulkhead/.Riprap length '. r",r
Avgdstance offshore r
Breakwater/Sill
_
r
-'�'�r
--
Max distance/ length
Basin, channel
Cubic Yards
Boat ramp
Boathouse/eoatlift
Bulldozing
Beach Bulldozing
Other
SAV observed yes no,
Moratorium yes no
Site Photos -yes no
RinarianWaiverAttached: ves no
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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
Agent or Applicant PRINTED Name
Officer's PRINTED Name
Signature -"Please read compliance statement on back of permit"
Application Feels) C.TnSl li&,%vensQheck#/Money Order
(, P Vs- W -4 4
Issuing Date 'Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: rnrtc-e sf o—t cy
Mailing Address: 57wz a)*%AQKd 96, Ofrd'Ate. �•��' I
Phone Number: ?57— 478 " Zt015-
Email Address: Mi (aep
I certify that I have authorized /t�✓Gwe�+�l�H e..c�� ¢ 'b� �fru�•1 n
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 2944 (t f l e'W 1);A,4 �
at my property located at 2t BG G yt8 S �, Iva rip
in 6/ifr6e - County.
1 furthermore certify that 1 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 Owner Information:
�n
Signature
Print or Type Name
Title
Date
This certification is valid through /Z i-0-0—J-AR��L

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: 'Ct S1uJy-•rtr
Address of Property: 9,\b(.�6ye 114 r)c ;Z 9 27
Mailing Address of Owner:;5 jg2 [l
�r t 2✓IQ �G� 1� l% t /�ihta i✓o�, f/ t4 L t 3`i b Z
Owner's email: 10oc6dr-cAr-0 d• Com Owner's Phone#:
Agent's Name: /3c4d< �Ak-aaAS Agent Phone#: Z51-r• 2b"7 — (9-2-4
Agent's Email: t OG 44 VV IlUteocls u r
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
permit has described to me, as shown on the attached drawing, the development they are proposing. A
kDO NOT have objections to this proposal. I DO have objections to this proposal.
If y have objections to what is being proposed, you must notify me n.',. urwsrvn ur waaiol
Fement (DCM) in to
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- A n /
I DO NOT wish to waive the 15' set blank
l( Signature of Adjacent Riparian Property Owner:
k Typed/Printed name of ARPO: SL/ Mailing Address of ``A''RPO: (ADS `(�)QaL / �� rc�LA/ � � �t`1 �- /]
z
F ARPO'semail:�imYrtn 23',J U I\n�m fAr�ARPO'sPhone#: �<i% 1P Z I &(3 6�'
J( Date: I� \�j' %��`waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

■ complete items 1, 2, and 3.
■ Print your name and address on the reverse nBd
so that we can return the card to you.
0 Attach this card to the back of the mailpiece,
or on the front if space permits. 1. Article Addressed to: L' Sa $„l ckel(
J �2,3 4W
II'llllll I'II IIIIIIII III I IIII II IIIII it IIIII ICI ❑o Adult signal
Certified MaIN'
9590 9402 6930 1104 1157 46 ❑ Certified Mail
❑ Collect on Del
n ndidu ail N„mher (transfer from service label) ❑ collect on t
7020,2450 0002 3104 1719 ai`
Form 3811, July 2020 PSN 7530-02-000-9053
■ Complete items 1, 2, and U.
■ 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 mailpiece,
or on the front if space permit. ___
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IIIIIIIilllllllllllll IIIIIIIIIIIIIIIilllllIIII
9590 9402 6930 1104 1157 60
7020
, PS Form 381
July 2020 PSN 7530-02-000-90b3
n item 1?
below:
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❑ Priority Mail Express®
❑ Registered MailT4
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❑ Registered Mall ResMcted
Delivery
Delivery
❑ signature ConfnnationTm
❑ Signature Confirmation
toted Delivery
Restricted Delivery
Domestic Return Receipt
D. Is oelNery aw,vm.1—........-... -
If YES, enter delivery address below:
Domestic Return Receipt

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