89980A - 56127 Elizabeth Avenue LLC

d[�1CAMA &DREDGE & FILL N° 89980 O B C DJ
Previous permit
y GENERAL PERMIT Date previous permit issued
[TNew ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by theStateof North Carolina, Department of Environmental Quality and the Coastal Resources Commission In an area of environmental concern pursuant to:
15A NCAC 1-1t i A I O k% ❑ Rules attached. ® General Permit Rules available at the following link: wvmdegBS,gov/CAMArules
Applicant
Authorized
Address /fIl okr /C $1ST'
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Phone # ( ac) 3.3/'7'31`/
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ORW: yes/0 PNA:
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Type of Project/ Activity _ Z A
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Shoreline Length
Access Length
Pler(dock) length
Fixed Platform(s)
Floating Platform(s)
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Total Platform area
Groln length/g
Bulkhead/ Riprap length
Avg distance offshore --
Break r Sill
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Basin, channel K
Cubic yards
Boat ramp .____
Boathouse/Boatlih
Beach Bulldozing
Other
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SAV observed: yes no w
Moratorium: n/a yes no
Site Photos: ye no
Riparian Waiver Attached: kes o
A buitding permit/zoning permit may be
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❑ TAR/PAM/NEUSEBUFFER (cirde one)
See note on back regarding River Basin rules
See additional notes/wnditions on back
(Please Initial)PUCe
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Permit Officer's PRINTED Name
Sig re
Issuing Date Expiration Date

4COM° FC°AMA ® DREDGE & FILL
1*
GENERAL PERMIT
, LN9 89980
Previous permit
Date previous permit issued
( ,4) B C D
[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:
n14 15A NCAC 1I A l o ,.---, ❑ Rules attached. ® General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name (o
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City
zip 27 7Y3
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AEC(s): ❑ OEA
❑ IHA ❑ UW ❑ SPIMA ❑ PWS
Closest Maj. Won Body P a Wt l i C.ts
-So IAn d
ORW: yes/do)
PNA: ye
Type of Project/ Activity
/ 0`-26r MCL
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s) =
Total Platform area "
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore -
Breakwater Sill
axdistance length '.2,n
Basin, channel
Cubic yards P
Boat ramp
Boathouse/ Boatlift '-
Beach Bulldozing
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Other � 1-
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SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no yf
Riparian Waiver Attached: tns o
A building permit/zoning permit may be required by:
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n ^ � ❑ 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)X
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Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature --Please read compliance statement on back of permit" Sign re
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Application Feels) Check Jl/Money Order Issuing Date Expiration Date

❑CAMA ElDREDGE & FILL ,. Nv 89980 ALB C o
VGENERAL PERMIT Datepre io slpermitissued
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 i'/`) - ❑ Rules attached. General Permit Rules available at the following link: vvww.deq.nc.gov/CAMArules
Applicant Name 3"
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Authorized Agent
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Affected ❑ CW
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AEC(s): ❑ IDEA
❑ IHA ❑ UW
❑ SPIMA
❑ PWS
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Closest Maj. Wtr. Body 3
ORW: yes/no)
PNA: yes, no
Type of Project/ Activity J._ 1 5
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Shoreline Length - !. I I V+
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Floating Platform(s)
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Total Platform area
Groin length/k
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Beach Bulldozing
Other
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SAV observed: .. yes no
-
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Moratorium. n/a yes no
'�
i -
'
Site Photos: yes no
Ri..H.r W..iV.r Aat,Ihed VPSnn
,.
A building permit/zoning permit may be required by:
-� e ❑TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions I 1 i\ 'j.
A I 1 ❑ 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)
(Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature --Please read compliance statement on back of permit" Signature
Application Feels) Check q/Money Order Issuing Date Expiration Date

AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Property Legal Description:
DEED BOOK: 2111 PAGE NO: 0035
PARCEL ID: 959517108918
STREET ADRESS: _ 56127 Elizabeth Ave. Hatteras, NC 27943
Please Print:
Property Owner: 56127 Elizabeth Avenue, LLC, c/o Mark Sisk
Property Owner:
The undersigned property owners of the above noted property, so hereby authorize
Doug Dorman of Atlantic Environmental Consultants, LLC to,
(Contractor/Agent) (Name of consulting firm)
1. Act on my behalf and take all actions necessary for the processing, issuance and
acceptance of permits and/or certifications and any all standard and special
conditions attached.
2. Enter the property to obtain site information including inspections with regulatory
agencies (Dare County, North Carolina Department of Environmental Quality,
U.S. Army Corps of Engineers, etc.) for the purpose of obtaining permits and/or
certifications.
Property Owners Address (if different than property above):
1390 Warrenton Road, Fredericksburg, VA 22406
Property Owners Telephone Number: 804-314-0434
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
Authorized Sig ature and Title Authorized Signature and Title
Date: / 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: Mark Sisk
Address of Property: 56127 Elizabeth Ave., Hatteras, NC 27943
Mailing Address of Owner: 1390 Warrenton Road, Fredricksburg, VA 22406
Owners email: [e-mail]'s Phone#: [phone]
Agent's Name: Doug Dorman Agent Phone#: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Ownerl
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
I DO NOT have objections to this proposal. I DO have objections to this proposal.
N you have objections to what is being proposed, you must notify the N.G. Division of coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at [phone]. No response is considered the some as no objection N 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 someiall of the 15' setback
wo
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Emmet Wood I
Mailing Address of ARPO: 8105 Seaton Court, Raleigh, NC 27615
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 06/12/24
`waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Mark Sisk
Address of Property: 56127 Elizabeth Ave., Hatteras, NC 27943
Mailing Address of Owner: 1390 Warrenton Road, Fredricksburg, VA 22406
Owner's email: [e-mail]'s Phone#. [phone]
Agent's Name: Doug Dorman 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 forthis
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.
_)� 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 943 Washington Square Mail, Washington, NC 27889. 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 sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjolt Riparia roperty Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Tracy Davenport U
Mailing Address of ARPO: 394 Arcos Drive, Mount Carmel, PA 17851
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 06/12/24
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021