89965A - Perry

~<>'t0AST.4t~li]CAMA □ DREDGE & FILL
f i GENERAL PERMIT
N9 89965 'ft!. s c o
Previous permit ___________ _
Date previous permit issued ______ _
New D Modification D Complete Reissue D Partial Reissue
As authorized by the State of North Carolina, Department of Enviro nmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC / 1 1 D Rules attached . [l] General Permit Rules available at the following link: www.deg.nc.gov/CAMArules
City r ·
Phone# ( _'>_) _'_<;c..h __ • _1
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[Z]ew
D1HA
L'2)PTA
Ouw
Affected D CW
AEC(s): □ OEA
ORW : yes/no~ PNA : yes/~';.)
Shoreline Length
Access Length -
Pier (dock) length l. '
Fixed Platform(s) -
Floating Platform(s) ---
Finger pier(s) -
Total Platform area
Grom length/# ________ _
Bulkhead/ Riprap length _____ _
Avg distance offshore ______ _
Breakwater/Sill ________ _
Max distance/ length ______ _
Basin , channel ________ _
Cubic yards _________ _
Boat ramp _________ _
Boathouse/ Boat lift ______ _
Beach Bulldozing _______ _
Other J ~ t
I-
SAV observed: yes (10 ¥7iT Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached : yes no
Des
OsPIMA
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OPTS
0Pws
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Authorized Agent ______________________ _
Project Location (County): ----'----'--:..:._:_---=---.:........ __________ _
Street Address/State Road/Lot #(s) ________________ _
Subdivision _________________________ _
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City __ ;___ ... _1 £'----'--'--c...!!...---------ZIP _____ ~/-· __
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A building permit/zoning permit may be required by:----=--''-----"-"-----'--'----='-'--------'-'-------□ TAR/PAM/NEUSE/BUFFER (circle one) Permit Conditions ________________________________ _
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)--~-----
Agent or Applicant PRINTED Name
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Signature **Please read comp li ance statement on back of permit••
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Application Fee(s) Check #/Money Order
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Permit Officer's.PRINTED Name j_
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Signature I
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Issuing Date Expiration Date
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION /WAIVER FORM
CERTIF IED MAIL · RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: ....._jF\C \(. 1: \;;. t\-1 l..l R--y f....:) ? E-i<.Ry
Address of Property : S' 0 S ~ l,~ Q'.) \. U i:... ·~. ( ~~ ~ I'-'._ tv•C ·c '7 q.3 J
MailingAddressofOwner: ~~"-~ ~s. A..-~ ·E
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Owner's email : j ?~ o '\ e_.C.B,.h uJl.."1 Owner"s Phone#: 2...s--2.-5 ° '-· l C:t. -4.S
Agent's Name : __________ _ Agent Phone#: _________ _
Agent's Emai !: _______________ R--ECEIVED
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Proeerty Owner) AUS ·1 7 2023
! he. reby certify that I own property adjacent to the above referenced property. The individual applypl,Q ~ ~i~ EC
permit has described to me, as shown on the attached drawing, the development they are prqeg~'Jj -
descrlption or drawing, wtth dimensions, must be provided with this letter.
.;.,./ I 00 NOT have objections to this proposal. ___ I DO have objections to th is proposal
If-,Y® ht;iV& objections to what is being proposed, you must notify the N.C. Division of Coastal
Mj,r4g♦ment (DCM} in writing within 10 days of receipt of this notice. Correspondence should be
ri#!~dto 401 S. Griffin St , Ste . 300, Elizabeth City, NC, 27909 . DCM representatives can a/so be
cfitltaeted at (252) 264--3901 . No response is considered the same as no objection if you have been
noti'fi.ed by Certified Mail .
WAIVER SECTION (Choose only one)
· 1 ur.,derstand that an y proposed pier, dock, mooring pittngs , boat ramp, breakwater, boathouse , lift. or
. gf◊in must be set back a minimum distance of 15 ' from my area of riparian access unless waived by me
· ' Ubis does not apply to bulkheads or riprap revetments). (lf iJ(OU wish to waive the setback , you must sign
. ihe appropriate blank below .) t'•·-..t.. "'-... 'I ·,. . r, .. _ ----
C:V1 \·,,<-7 : . . ~.;'-_~.
t DO wish to waive some/all of the 15 ' setback~~ ~:l.-. \ . ~-~ ( y-;4·,
Signatare of Adjacent Rtpanan Property Owner
· -OR-
. /'v'\ ··--"1 I 00 NOT wish to waive the 15 ' setback requirement {in itial the bia nk, _.,_· --'---"--,-I -
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-;..,... .. .
Signature of Adjacent Riparian Property Owner: __ / __ ,._,._.;._t_ .. •_,_';...._, -----:_,,_c.-~ __ -,..""" .• _J ___ _
Revised August 2022
!AX PCL . NO 6817·-00-58-0652
HWER SI-IORC !Af,'MS-, INC.
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