89818A - Connell

N9'"89818 A s C D ./
Previous permit _________ _,~1------,,_/_
Date previous permit issued _____ V_..._ __
0 New D Modification D Complete Reissue D 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 -~-'-----'---'--'---''-'--'e.._--------□ Rules attached. ~r General Permit Rules available at the following link : www.deJ:l .nc .gov/CAMArules
Applicant Name --="--'....:....~~:....!......!....!c...._---"-'----=;....!..J'--':.....J.~-----
Address -+-"""--'--...C...,-'-"--'"-'-ic...o~~--'--'...----'--"'-'-----''-=~-----
Phone# (-
Email ---'----'-_:._:-'--'--'---'...:....,;..-"'--'--'-L.:..:--'--'---'-....:....:'-"'-'-~--=--'-'----"=-=,...,e..u...:=.=--i--'--'---'--'--"'-'
.,;
[9 iis Affected Dew ~EW ~PTA G PTS
AEC(s): □oEA D1HA Ouw □sPIMA 0Pws
ORW :yese ' PNA: yes[ni:,
Authorized Agent -----'-----"'----"-~-'-=---"d-'--''l'.'.'--'-/-•._i'\,_,__'---'""-","_t.__,,7-".-----
Project Location (County): __ ..._(__,,'---'.........,---'---=----=----------
Subd ivision c:: .:::.
City .-t, ,.... r '-t _. C \:::-
Adj . Wtr. Body ((. \
Closest Maj. Wtr. Body
Type of Project/ Activity -----"::C..:....-+--'----"--'----"a~-'-'-':...;_----"::e....:...:'--'--l::::....:..........:"-"".<:....l'---'~.i:........l...-'...:::;....___:..~....!..!...!..!...--1..---'--'1...L.ll...?....-_,_~ _ _..:c;:~--....!....:=...,:....!......i...• .:::O.:+-----
\ (sc;ie:( -:,(,.1
)
Shoreline Length _~I _/~· _t"_1 __ _
Access Length---~.-/ ___ _
Pier (dock) length __ ....,/ ____ _
Fixed Platform(s) ___ ..__\ ___ _
\
Floating Platform(s) __ -4-\ ___ _
Finger pier(s) _____ \....,.__ ___ ~
Total Platform area ___ ...;;-__ _
Groin length/# _____ I ___ _
~ Riprap length ~1~0~?:,~_• __
Avg distance offshore __ 'Z=----
Breakwater/Sill ___ ~1-----
Max distance/ length __ ..,__ __ _
Basin, channel ____ ....,,. ___ _
Cubic yards ______ ..._ __ _
Boat ramp ______ .....!.,.---
Boathouse/ Boatlift ___ ___,_ __ _
Beach Bulldozing ____ __... __ _
Other ________ '-----
SAV observed: yes ~ ,.--; Moratorium: (n~a ) yes no
Site Photos: --es no
Riparian Waiver Attached : es no
r-i.,
+-
--+
+
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r
A building permit/zoning permit may be required by : ---'-.~-'--"-'-....:.....J>....>.:!'....:---'""-----'---"':CCJ..'......L.+---
Permit Conditions ______________________________ _ □ TAR/PAM/NEUSE/BUFFER (circle one)
D See note on back regarding River Basin rules
D 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 1. ,\ ,.., i I . .-•;/
Agent or Applicant PRINTED Name . Permit Officer's PRINTED N,.ame
, . 7' . ' .,l I,, •• -/, •
I' I l
Signature **Please read compliance statement on back of permit** Signature
( cc
,; .
Application Fee(s) Check #/Money Order Ex i ration Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: K/ch~,.cl ;J , { v,11-1..r'//
Mailing Address:
Phone Number:
Email Address: ( ,' { h ,;~ r dc'ff I" ,-1,, v•-rt .7/)11 (,,Ji f €i2:jrh4t / q (~/V\
I certify that I have authorized _D ..... a .... c1 ..... : ..... c ..... l ... tl....,,, ..... d ..... .,.'-? .... • , .... 1,J ..... ,, .... ,d .... r:_7 __________ _
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Bvik~,A1,~ Jir/'flf4u'~
at my property located at (0 4 ~V c.?c.'71 l7vtrJ.c Dr, Ref/£ f!l(P{ll ti
✓
County.
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:
Signature
A✓c6«o/ A. c _ _,e-4
Print or Type Name
Title
I ··)17 ?
_J[__/ t--l / ;. V},, 1
Date
This certification is valid through __ / ____ / __ _
N.C. DIVISION OF COASTAL MANAGEME-NT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL · RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top port ion to be completed by owner or their agent)
Name of Property Owner: /(,c./20,.v~ C,,..A/e,/)
Address of Property: Jo~ W~.Rv<:-k .Pr1V'1!.--Cvrr1f-t./,._.k, )VC-~,»
Mailing Address of Ow ner: _::::..>o....:;:.:.•·-~_e __________________ _
Owner's email: t?t:.i,.../4r-f-Lr<?rr.e!J,/;"11J~Nner's Phone#: §tJ3"-3~o-UJ?
Agent's Name: {b,11\ 14-11 J✓o?"":i?::Y::::/ t 2... Agent Phone#: :2-'5 2.-/,.,ff) ,.... '7 Jr;_ 2..
Agent's Email: ~ 7 7 ck n ,1 b@ ;'} ~, '/, t"& ".1:-:J
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. Th e individua I applying for t h is
permit has described to me , as shown on the attached drawing, the development they are propos ing . a
descri tio or drawin with dimensions must be rovided with this letter.
-~-I DO NOT have objections to this proposal. ___ I DO have objections to th is 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 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
I understand that any proposed pier, dock, mooring pilings , boat ramp. breakwat er, 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 t he setback , you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
I do not wish to wa ive the 15' setback requ i rement (initial the blank) _____ _
Signat ure of Adjacent Riparian Property Owner: ____________ _
Typed/Printed name of ARPO: ~ h vv W · :J~ l \'c "'---::U:S:: ·
Mailing Address of ARPO: \ l '=) \JJ .::> e&. ·J)._,_c. ~ 1),.,.. (\J..,n .\-u.c. k 'N C. ;7-1 q ?-'1.
, . _ . . 5 ,.,__ ... d . I:.~ l~ 11-. ,_. , \ 1
ARPO's email: _j t. h.,,, vJ J ~ . ..l,c.~ '-'' e9 ARPO's Phone#: V ':> J .J ~ 4 7,.. lo ~~.:L
Date: 7 / 7 { ':;2-3 *waiver is valid for up to one year from ARPO's Signature* •.
--, UNITED STl!TES ~ POSTJ.ll. SERVIC~E.
GRANDY
123 FORBES LOOP UNIT C
GRANDY, NC 27939-9998
[phone] 12 07 p~ 07/10/202 3
Product
.......... -· ·-····--··-. ---·..,.
OtY Un i t
Price
First-Cl dSS Hail® 1 $0 .6€
Latter
Cur ,~1 tuck, NC 27929
Wei gt1t : 0 1 b O. 70 oz
Est li nated Delive r y Date
,ied 07/12/2023
Cert 1 f i ed Mai 18 $4 . 3~
Track i ng#:
7022333000009789 :857
Ret ·n Receipt $3.5~
Track i ng#: 9590 9402 7890 2~?34 6997 06
T~al $8 .~
Grarid T,:na 1 · $8 . 5E
Debit C;1·d Remit $8.5E
Ca rd Name: V[SA
Acc 'JUn t #: X:<XXXXXXXXXX3!329
App r oval #: 042448
Tr a1~action #: 519
Rec-3 pt #: 020916
Debi c Card Purcha s.e: $8. !56
AID: A0000000980840 Chip
AL : US DEBIT
PIN: Verified
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Replace existing
Bulkhead return
1 New bulkhead 2'
In front of existing
Existing boat lift
109 wood Duck dr
Existing dock
Bells Island , Currituck NC
Replace existing
bulkhead Return