89826A - Shearon

0EMNI ❑N9 89826
CAMA ❑DREDGE &FILL 1C e c D
GENERAL PERMIT Previous permit
� Date previous permit issued
❑Y, 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 ❑ Rules attached. N General Permit Rules available at the following link: www.deq.nc goy/CAMArules
Applicant Name
City
Phone # ( )
Email
State ZIP
Authorized Agent i...
Project Location (County): !c, ,t
Street Address/State Road/Lot #(s)
Subdivision
City Z
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body (nat/man/unk)
AEC()s: OEA IHA UW SPIMA PWS j
❑ ❑ ❑ ❑ ❑ Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
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
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ BoatliR
Beach Bulldozing
Other.
SAV observed: yes no
Moratorium: n/a yes no ----`-
Site Photos: yes no -----
Riparian Waiver Attached: yes no _
A building permit/zoning permit may be required by:
Permit Conditions
I N
(Scale:
❑ 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)
Agent or Applicant PRINTED Name
Signature **Please read compliance statement on back of permit**
,� 1
Application Feels) Check k/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Kin -me of Property n%.ginef Rene-lactinn Permit.
Mailing Address:t�St�c-
nl70ti
Phone Number:
Email Address:
I certify that I have authorized r'-A�v, s / L .y
AGent; nOl t:'u-1
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ( GyL
at my property located at &u �- Exi �� n
in C.tVc,,,4 iv C4Unty.
l furthermore certify that / am authorized to grant, and do in fact grant permission to
nil/ision of Coastal MnnagemeAf gtaff fh0 I nCml Parmif nff, i�er an�rl 4hair _Hants to ontcr
,..y...I
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
a tr Nan
Title
t 2'7
Date
This certification is valid through 1 2.7 /
RECEIVED
SEP 13 2023

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: a l lw JG �HiC—hZo�,
Address of Property: 'vU� SU1v
-VJlcNTu�
Mailing Address of Owner: Svl�CS
i f7C �tL1�
tit O �iL
2-� `j 3 '�
C_ci^
Owner's email:hPa. jwl8wner'sPhone#: 2S2..-ZS�—�f�f �
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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 401 S. Gruen 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, 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 sian
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
i
Signature of Adjacent Riparan operty O er
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) SEP 13 2023
Signature of Adjacent Riparian Property Owner:
CM_EG'
A
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:�� ?? ARPO's Phone#: a,O oL— --1J Date: C� 7—00 "waiver is valid for up to one yearfrom ARPO's Signature"
Revised July 2021

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)
a --
Name of Property Owner: ``//= c_c$R6 c�,1ta,&JZ -J
Address of Property: l"(,-a _ - � TlvJ &)1-1 2�79
Mailing Address of Owner: CayS SJ 57C �!l _ ��C=thRi11� /�L Z—�`j 3Z
hx@ .
el0ip-den�i Owner's email: �� CQ, �`m Ow'C"ner's Phone#.
Agent's Name:
Agent's Email:
Agent Phone#:
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 for this
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 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, 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 mus si n
the appropriate blank below.)
I DO wish to waive some/all of the 15' setba
ZI
. natu ofA jacentRiparia operly O er
-OR-
.FrEI V ED
I do not wish to waive the 15' setback requirement (initial the b ank)
SEP 13 2023
Signature of Adjacent Riparian Property Owner:
TypedfPrinted name of ARPO: LAt(, A+w6) ILu&ntNE JAyLp61)4 i "i vc-l� ✓
Mailing Address of ARPO: I IZ ally rrti� YC • ��o2FO1 4Z , VA. 2—LEP
ARPO's email• AGtrieafOrJewQ me.CARPO's Phone#:-7 7-201- 0"
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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RECEIVED
SEP 13 2023
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