89937A - Richards

J1*"U`r", ❑CAMA ❑ DREDGE & FILL �11—NO 89937 A s C D
2 GENERAL PERMIT Previous previous
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 ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
Affected ❑CW
AEC(s): ❑OEA
ORW: yes/no
❑EW ❑PTA
❑IHA ❑UW
PNA: yes/no
Type of Project/ Activity
Chnreline I env h
ZIP
❑ ES ❑ PTS
❑SPIMA ❑PWS
Authorized Agent
)
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body t
..J
(Scale:I )
Access Length
Pier (dock) length
Fixed Platform(s)
3-.
Floating Platform(s)
Finger pier(s)
Total Platform area
I
I
i
Groin length/fl
—�
Bulkhead/Rlprap length - I
I—
Avg distance offshore '-- - --
-
---I-
--
-
Breakwater/Sill
-
—
-'—
I
Ctt
Max distance/length--
Basin, channel—j--
I
Cubicyards-
-r-
(.
Boat ramp
Boathouse/ Boatlift i !
--- 6-
i
`,
r
-�
Beach Bulldozing _
..'i—
Other -
(
L
tk
j-
-
I
SAV observed: yes no
-
—._
_
_
Moratorium: n/a yes no
-
Site Photos: ,Yes, no
i
I
',.
..._
-
�-
'..
.,. —
;__
__.
—
Riparian Waiver Attached: yes no
._ LL
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) ) I 1
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
#,
Application Feels) Check q/Money Order
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: �h6k, r�V PJIM f'tCYYlyd3
Mailing address: 11)114 Naesy)O(,l moo(
$uCkn VA
Telephone Number: 116 • 2 • 2,q-7!4
1 certify that 1 have authorized Bro mn,s tat.O I tzqI[ti rrnsIrZ . (agenUcontractor),
—
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of t�u.1dQ�
This certification is valid through Ma4 (date).
(Property Owner Information)
Signature
Print or .: Name
6Yv A}Cf
Title, co. owner or trustee for property
�i2i 1202,3
Date
JUN26621
a-;7. , ---2-,a . `may
Telephone Number

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RECEIVE
J U N 2 5 2023
DCM-EC
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DIVISIONOF t'.
ADJACENT iNOTIFICATION/WAJVER FORM
1 � �
t portion i be COMPletod by Omer or their agent)
Address of Prepody,
Name of Properly Owner:
Mailing
ht w • ..
Address of Owner♦ i it
Yfi y
i s tv is .. ♦ i
wv +I s pi •A r�i
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom oodfon to fso CqMnlatod by ,(he Adlacont EfVnfty O+vnav3
! beraby caffifif that I own properly adjacent to the above referenced property. The Individual applying for this
ponnit has describod to me, as shown on the attached drawing, The development they are Proposing. 6
Ljicv drawl w, vnit dimea s 6ns oqqLtjb6 provided V+ h th, t r,
I DO NOT have objections to this proposal. —� 100 have objections to this proposal,
i you have oblootions to what is being PMPQsed you—mdst n-o*— the t .. Divtalon of Coas tot
Managoment (DCM) in wd ing within 10 days of recelpt of this notice. Correspondenco should be
ma sd to 401 S. Griffin St., Ste. 304 EPrtaboth tatty, FIG, 27909. OCM rnprnsontaHves can also be
contacted at [phone]. Pto response is considered the some as no obJeet ion If you have been
notiTed by Certified Ma it.
WAIVER SECTION
I Understand that any proposers plcr, dock. mudding pilings. boat ramp, breakwaler, boathouse, lift, or
groin must be sat back a minimum distance of W from my area of tipadan access unless wahrod by me
(this do" not apply to bulkheads or nprap revotments), (it you wish to waive the setback. You m9a sl
the appropriate blank below.)
I DO wish to waive sometail of the 16 setback
Signatumo —of Ad}sco RiRiparian Pnijierfy Owlet'
-tJR-
t do not wWh to waive the 157 Setback tegnirament (initial file blank)
Signature of #dsar_atrt tzilsartan f'tpjratiy Ct+nta€; ,�.4 ' a ,cs`.ru'..�a �_ , �. �:,Y��'" �"*
Laec 6hrtta It&!'x.£27rrpm+?c 3e- aa3 }"
waning Address of ARPU
r
ARPtb's opted;
ARPO's I*hdno#:„
Date, _. _: wuhdtr is valld tar up to one, year tram ARPg's Signature'
Rovised:futy 2021

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:76.597 36.030 Degrees
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