89823A - Walker

~ottOAST.f(~BCAMA □ DREDGE & FILL
{ J GENERAL PERMIT
N9 89823 c ✓
Previous permit ___________ _
Date previous permit issued ______ _
G 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 t"" 1 1 , I' D Rules attached . ~ General Permit Rules available at the following link: www.deq.nc .gov/CAMArules
Applicant Name --=1-....:.....:...:....:..:.:.,..::.:._..:....:._:....::.;~e-..;....=""---"----------
Address ---''----'--"'-'--'-------'"--'----=---.!.--'-'---=-..._-----
City _ ___::=--'--'--'-------'-"'---'-'1---
Phone # ( __ ) _________ _
Email ________________________ _
Affected □ CW
AEC(s): □ OEA
ORW : yes/rro 1
G 'ew
D1HA
[:]~TA
Ouw
PNA : yes/no.,,
[21 es
□sPIMA
[SPTS
0Pws
Type of Project/ Activity _...!.:::_L_~.:.:..c:_:__.=:-__:___::...___::..._____!..!....!__J!...!...:a..!...:._..:..::__:....i::.::..c.!__:....::::;_---1oc....=:..:....;._!__!=~;___L_.!,.____!_~---1....!::...~i..!.....!..:l....L.!~:.,,_--
, I
Shoreline Length-~'-,.,~· ____ _
Access Length----~~---
Pier (dock) length-----,'------
Fi xed Platform(s) _______ _
Finger pier(s) ________ _
Total Platform area _________ _
Groin length/# ________ _
Bulkhead/ Riprap length ---=~---
Avg distance offshore---='----
Breakwater/Sill ____ ~/ ___ _
Max distance/ length --1-'----
Basin , channel-----+-----
Cubic yards------+----
Boat ramp ______ ...._ __ _
Boathouse/ Boatlift ----+----
Beach Bulldozing _______ _
SAV observed:
Moratorium: n/a
Site Photos :
Riparian Waiver Attach ed :
yes
yes -ye s
y:;.-'
G\ _,
6)
no
no
no
A building permit/zoning permit may be required by : --~-'--'---"---'--'-'-'----'------'---';....:..c'--'--''-'-->...::..:'------
Permit Conditions ______________________________ _
Agent or Applicant PRINTED Name Permit Officer 's PRINTED N;;i me
Signature **Please read compliance statement on back of permit** Signature
. --' /
Application Fee(s) Check #/Money Order Issuing DatJ
□ TAR/PAM/NEUSE/BUFFER (circle one)
D See note on back regarding River Basin rules
D See additional notes/conditions on back
(Please Initial) ___ V ____ _
I I
Expiration Date
'! " ~SION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date f3 -S-~ Z 3
Nwc of Ptvperty Owacr Applyiq for Penn.it:
,0/2&1iJ /Jq/fe r
Mailiag Address: -
118 Fdg;ewa.1?1: /)r;
Gt0uc/y tvC-k 713 t
l certify that I haYe authorized (agent) 21111 I{ Poy s 6/tsl to act Oll my
~ for the purpose of applying for aad obtabd-. all CAMA Permits· necessary to
w or~ (adhity) / f:6 1 of /Juk /t eaef
'
at (my pntperty located at> lf12 Ec(gewci fer a
Tbb c:a1iticatio11 is Ylllld dim (date) ________ __.
t: J:'"'"'"" :z:✓~ ~ Sipature
<Z/~!1.o;J
Date
N.C. DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONJWAIVER FORM
CERTIFIED MAIL · RETURN RECEIPT REQUESTED or HAND DELIYERY
(Top portion to be completed by owne r or their age nt) ::~a-3:j M~~P), ..
Malfing Address of Owner: !t/8 i::-qgewa.lev-U ®0dj; A/<? ZZ? 51 .
Owner's email:---------,.-,--Owner's Phone#: _______ _
Agen t's Name : fkr--1 h 2141 1 •~ Agent Phone#: ,7-§'Z !?f?' 0 ?fl
Agent's Emaft : ___,/-lj...., ..... ch .... o ..... 7~t2..._t .... ,..,.Jtl ........ 13....,.·2..,..q~kt)-~r-O=--ff,1_._ ______ _
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent 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 . f!l .
desatption or dfawing . with dimensions. must be provided with th is letter.
I· DO NOT have· objections t9 t his proposal. __ I DO liave objection s to th is proposa l,
If yo have objections to what Is being proposed, you must notify the N.C . Division of Coastal
Management (DCM} In wrltlnfl within 10 days of ra~pt of this notice. Correspondence should be
maHed to 401 S. Grlffln St, ste. 300, Ellz.abeth City, NC, 27909. DCM representativu can also be
contacted at [phone]. No responae Is considered the same as no objection If you have been
notified by Certified Mall.
WAIVER SECTION (ChOOff only one)
I understand that any proposed pier. dock, mooring piUngs , boat ramp , breakwater, boathouse , lift, or
groln must be set back a minimum distance of 15' from my ar\l3 of riparia n access unless waived by me
{this does not apply to bu lkheads or riprap revetments). (If you · to~ the setback, you must sign
. the appropriate blank below.) // /
I DO wish to waive some/all of the 15' setback r\..,.,,,..,........,/, ,.,-...,. I
-OR-
Sig ure Adja~ Riparian Property Owner
I DO NOT wish to waive the 15' setbact<; requirement (Initial the blan k) ____ _
.,.. ...... -··-.... .,,,,Ow...., d ~
--o! ARPO, J) •N«.J /o u;,'1< 1 ,./,Jj
Malffng Address of ARPO: / 6-0 f.~ q 1,1,j~ 7' h J ..... , v , . (i'.,..,.M/A 7 # < 'Z. 7 9 g,
... $
ARPO'a email: /'J ()./-/,'}ot,.,/1✓1HJ/IJ~,-uw-v''ku>o ,. Phone#: f 1-... ~76,1 -/,t'1 /
•waiver Is valid for up to one year from ARPO's Signature•
Revised August 2022
iuH(JJ~
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL · RETURN RECEIPT REOUESisP or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property OWner: ✓o/4 ~ tJc<if ff
Addnlssof Property: 1tB McteuJc(/e r th
MalBng _AddrassofOwner: 118 ~i;wq_fe r Vn Ort:?~ Ale 219'39
Owner's email : -------~-Owner's Phone#: ______ _
Agent's Name: f?a rz 'ti 51:n/ ti Agent Phone#: Z-5'Z 579 0 7'7 7
Agent's Email: f&c13a ctrflg«ltOC>, CO i t '( '
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
lBgttom DOftion to be COf!!pleted by the Adjacent Property OWntcl
i hereby certify that I own property adjacent to the above referenced property . The indMdual applying for this
permit has described to me, as shown on the attached drawing , the development they are proposing. A
d~ or drawing. with dim~. must be provided wtth this letter.
!·DO NOT have' objections tp this proposal. __ I DO liave objections to this proposa~
If you haw objections to what Is being proposed, you must notffy the N.C. Division of Coufal
Management {DCM} In writing wtthln 10 days of teCfllpt of this notice. Cotrespondwlce should be
man.I to 401 S. Griffin St. Ste. 300, Elizabeth City, NC, 27909. DCM n,presentatw.s c:an also be
contacted at (252) 2H-3901. No response Is considered the same as no objection If you have been
norffled by Cerllf1ed Mall
WAIVER SECTION (ChOose on ly one}
I understand.that any proposed pier, dock, mooring pifings, lx>at ramp, breakwater, boathou$e, lift, or
groin must be set back a minimum distance of 15' from my 81'\18 of riparian access unless waived by me
(this does not appjy to blllkheads or riprap revetments l. (If you wish to waive th e setback, you must sign
the appropriate blank below.}
I DO wish to walVe some/all of the 15' setback ___________________ _
-OR-Signature of Adjece~roperly ~
I DO NOT wish to waive the 15' setback requirement (Initial the blan~
Signature of Adjacent Riparian Property
Typed/Printed name of ARP<>: \-<:;;:,), {, ca & 0<'.h l , d ~p:£ lf t::
Mailing Addrn• °' ARPo: P-H o Edg e u.2 a±:ec D: ChmA0 , bJ c , :;;rJ q 3 °I
ARPO's email: _________ ARPO's Phone#: ______ _
Date: _______ *waiver Is valid for up to one year from ARPO's Signature•
Revised Augu~ 2022
✓
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