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NXCAMA ❑ DREDGE & FILL
3 GENERAL PERMIT
N° 89940
Previous permit
Date previous permit issued
® B C D
KNew ❑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 r 14, 1 ol 00 ❑ Rules attached. ® General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Street Address/State Road/Lot #(s)
Phone # (TV IJ !015J — 1 J 1 7
Email KGVe.ty0hoi, w- C C,�fjr Com
Affected ❑ CW X EW [ZPTA ❑ ES ❑ PTS Adj. Wtr. Body L. f\U i T iiCL rr), _ ., ye y— ( an/unk)
AEC(s): ❑OEA ❑IHA ❑UW SPIMA ❑PWS Closest Maj. Wtr. Body 1"f ltlGlrWil•'� aLLAd
ORW: yes/Oo PNA: yes/
Type of Project/ Activity Co Yk6 �ruuCy Cl (nJ x 'I d PJ r f^ tom/ 1(01 x /�c r lrL%�
Shoreline Length
Access Length r p�
Pier (dock) length (6 K TO
Fixed Platform(s) b r 1C lic r
Floating Platform(s)
Finger piers)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other_
\O�yA7 q L (Scale:
,Q
w
S.w-r-.1
V
QY
`C�
SAV observed: yes ® ( 6%�
Moratorium: ai� yes no
Site Photos: i® no 1
Riparian Waiver Attached: W no /'+ I
A building permit/zoning permit may be required by: �\ n Wo, I!, lllw'n Rt
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Signature **Please ead compliance statement on back of permit** Signature O
i a06 1 °� 2403 17/25
Application Fee(s) Check#/Money Order Issuing Date
II
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:K (.' ' ' ` '� /iIau-Y'eF*x
Mailing Address: 3o6 Cliow--,, -Tnrr
rA 4-ogn NC 27 93 2-
Phone Number. 7.5 7^ 6 65 — 9.5 q —7
Email Address: k.5ferhA6usekP%V Qw.
r'a V I certify that I have authorized T',,s L;1GC �ev
Age t I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Ka vc. eri Sfina �,p er t'Y�rjc4'�
r
2(t tied yoxG` P"?r L.�-t>° I&IX161
at my property located at 3n1, C470W S r1 -Ty^A i \
in County.
o-V
I furthermore certify that I 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:
Ma"re-pr M.
or
06 Iz? 12OZ
Date
This certification is valid through 14 1 3 ( 1 Zo Z3
i
[[� !` ,�y
1^`r. r a..r i:. i . .
JUL 1 9 ZBB

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)
l/
Name of Property Owner. KP/i l� `/� %�'`LIGtYz2+1 JT�/Q-� N J I
Address of Property. 3o� C—r'I a r �zt' ` (r (- JIe'"�ri /vG Z 7 c1.3 Z
Mailing Address of Owner. _W, GLIOt.k.kn Tr�i Eii end A.)C z 7`t3 Z
Owner's email: ks-ktgAomge(?t;unoX<*, Owners Phone#:
Agent's Name:
Agent's Email:
Agent
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. g
description or drawing with dimensions must be provided with this letter.
100 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 or Coastaf
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Gdffin 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 rlprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 1 Fastback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 16 setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: lr-�,
Typed/Printed name of ARPO: {1 Ifi t.i5 r;
Mailing Address ofARPO: 3 /% P14-)TATIOIJ DR—
o ill
ARPO'semailk/gRrtJc.9yr� 7Q.nrcvt.�ARPO'sPhone#: 7i7.264.7�9$`
Date:.) 8; J ( V A `� max' -*waiver is valid for up to one year from ARPO's Signature
Revised July 2021
J U L 1 9 2523

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to `b/e completed by owner or their agent)
Name of Property Owner: �21 4% y- McAfAt ,eern rJ,rTe lnNOl.(S�-
Address of Property: -3DL C-4owan ��c6tt &44. i0v1 I\iL 27%.?2-
Mailing Address of Owner. 306 C ' or.4411 ( C- e o+OK NC. 2 % 932
Owner'semail:Ksk:,1lo'(se +an0,c�+OwneraPhone#:-751-G8�
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent tothe 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.
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 me N.G. urwsion or uoasrar
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 it 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' setback
Signature of Adjacent Riparian Property Owner
-OR-
1 do not wish to waive the 16 setback requirement (initial the blank) 40
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO: ,DHy 0'N 1. • 13 w -1.0k
JUL 19 2023
, r.,.
LIJ
Mailing Address ofARPO: 31Z oHnwnd rRml 11DgnrmArn0C 7.`79Rp
®DAwC
ARPO'senail: ARPO'sPhone#: 75R-631.7R37
Datc' a I16j -2 't 'waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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