89865A - Thomas

O N 89865
B
]CAMA ®DREDGE &FILL c�
A
Previous permit
GENERAL PERMIT Date previous permit issued
%C]New []Modification El Complete Reissue ❑Partial Reissue
As authorized by the state of North Carolina, Deparunent of ErMronmmental Quality and the Coastal Resources Commission in an area of etMronmeno lal concern pursuant t
I SA NCAC W1' W ❑ Rules attached. Certeral Permit Rules available at the folbwirlg link: ww rodeo tic cov/CAMAnA
Applicant Name--h C L-LCN60LYICC'_ IJlCIMA:k Authorized Agent t I.La.
Address _ `T69 r'CP..f!ew� o br, Project Location (County): �EA j.ad1Ll
city - state V0. Zip 23323 str,,tAddrw JStatn R.WLot#(s) �( '�l.`5 1(6 If It tS
Phone#(' `) 11��l.,
bt-,q(D-A �.._._ rSt �.A.7��(
Email �(tACALA- y 0t104wao. Ctym Subdivision ti� 1yL4 S i�0,,@S
city t �� t, aP 1a7gwit
Affected ❑CW ®EW ®PFA ®Fs ]MS Adj.Wtr.Bod,, Attie ,%ai-le Stluw,M1�s]st _(�'mudu
AEC(.): ❑ OM ❑ INA ❑ UW ❑ SPIMA ❑ PINS Closest Mal. Win Body A ` ia"e �h'�=
ORIN: yes/0 PNA: yese
Type of Project/ Activity
Inn (ate: �1,-10
Shoreline Length_.-_tYstr
f
access Length
Pier (dock) length t i l t I J � � "' I I 1 t, J I I` • , i h' 1 . _.
Fixed Plathsrm(s) ... I I J t-
,�
Floating Platform(s)
(—L.�.j
1
Finger piers) f... i- t I 1..• , , Yy.-.+`i 1 I - F T -r _.., ., 1 _
1 t
Total Platform area
i 1 i i i t I 1 ! i I 1 1-- ( C.•y �ft> k 1 � 1 f..
Groin length/# 1 1 1 1 r i J l + 1 1 1 1 1 1 i 1 I i t I I�
ulkh 1 1 1
/Ripraplength too/ .-r--+ t 1 r-.>'. i•--�-�-+ -- 1 `f_4 f i
1 1 I , I I 1 1 i i ! 1 I t I J y iY�� r try
Avg distance offshore , J 1 I I� ii + i , I , (1 1,
_.y.---i--�-
Breakwater/SIII;-
Mmdistance/ length
I 1
Basin, channel
- -'
_ ...J__
z1f
CabECyaldSjBoat rem pBoatllRBeach BuIldoZing vi rother---..t-_ i 1 i__.I___ i i t I t 1 1 I
F- - -�- - t _ .�l
I I V i 1 t ; i -.1
SAV observed:_�\ Yes t-p-.�-t__,.-� 4
Moratorium: f1(a..r yes n0
She Photos: .��^f no 1-�-it _f._� . 1
Riparian Waiver Attached: yes l.s J 1..-. _. .r. ! ..__.1- "___._.
A building permR/toning permit may be required by: Ct vLs 1. ❑ '
TAR/PAMMEUSFI6UFFfR (circle ore)
Permit Conditions ----
❑ See note on back regarding River Basin ru
----- ❑ Sea additional notes/conditions on back
ro, native tun munnortagTWATAPPD(TO THE PROJECT AND REVIEWED COMPLIANCE STATEMENT- (Please Initial) P A .)
pPermit trancepll�t s rnlrc I eu name
Slgnatu a •'Please read compliance statement on back of permit" Signatgl',e IF
ast 241 YY/21 f23 '/Zr!?a
Application Feels) Check#/Money Order Issuing Date Explmdon Date

AMA ® DREDGE & FILL
GENERAL PERMIT
®New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N° 89865
Previous permit
Date previous permit issued
013 C D
As authorized by the State joff North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
te
15A NCAC I I (W ❑ Rules attached. ® General Permit Rules available at the following link: www.deg.nc.gov/CAMArules
Address toll —Vme VywrYW-±
UT:
Project Location (County): t-Cr wnosn F"
r
City `�` seweoy State
1%Q
ZIP 233 s2 3
Street Address/State Road/Lot #(s) S
— 441 3
Phone # ('M)
41 6 �
tty�oy
Email Va Cc A.q 2CIt/CAF`OU-COIN
Subdivision
`C�
City Ia4r k-96C,4 ZIP
Affected ❑ CW ® EW
Q PTA
N ES © PTS
Adj. Wtr. Body t h to,S 1 (�'man/unk)
AEC(s): ❑ OEA ❑ IHA
❑ UW
❑ SPIMA ❑ PWS
A flop-
Closest Maj. Wtr. Body (rJp MCt r(le &.1k1i
ORW: yes/0 PNA: yes/0
Type of Project/ Activity_ ctliOVr o1 r\,e W bv,\ 0-6 a' 0L%N- 2X'iS'�M�t
(Scale: 1r=20 )
Shoreline Length / Io r
Access Length
\R r
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/# '-
ulkhe /Ripraplength ioo�
Avg distance offshore
Breakwater/Sill ^�
Max distance/length Zr
Basin, channel
—�
Cubic yards
Boat ramp "s
Boathouse/Boatlift
'CS
Beach Bulldozing
Other
t�rt,
,—
Q �Szt
SAV observed: yes
g
Moratorium: KZI) yes
no
Site Photos:
no
Riparian Waiver Attached yes
N .y
/Zxz,-�X/ - , <�,
/a
A building permit/zoning permit may be required by: �er9 to tlhQ ✓ts C..Cxati�r.
Permit Conditions
THAT APPLY TO THIS
Agent or Applicant PRINTED Name
Permit
it �4
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature **Please read compliance statement on back of permit** Signature i
b �lfx�, k
Application Fee(s) Check#/Money Order Issuing Date
Expiration Date

et tpAS,4lAMA ❑DREDGE &FILL NO 89865 a'. B C a
'�❑C
Previous permit
GENERAL PERMIT Date previous permit issued
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. ❑ General Permit Rules available at the following link: wwwde nc yov/CAMArules
Applicant Name
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/do • PNA: yes/no
Type of Project/ Activity
(Scale: )
i
Access Length
—
Pier (dock)length
i
-
FixedPlatform(s)
i
I--i
I
i
Floating Platform(s)
i
I
n
T
Finger piers)
_
�
I
Total Platform area
Groin length/1t
Bulkhead/Riprap length
-
t-_
Avg distance offshore
If'
Breakwater/Sill
-
—
--
Max distance/ length
,,. _
. -
__.
_
J
'..
...
.�-
..
....
N
09
..
Basin, channel
-I---
Cubic yards
1
/
i
I
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a - yes no
t--
—
----
—
Site Photos: yes no
-J--
on.�.�..
A building permit/zoning permit may be required by:
Permit Conditions
❑ 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
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check #/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: A9,te2� �` Lkl* 77-c'f-
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: / xd Z-1&W
r
at my rope, y located at " 7 k� —
nn
in -e/CL201i !e"-S County.
1 furthermore certify that 1 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
Print or Type Name
Title
,taC%�'
Date
This certification is valid through / /
9R)

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property OWne
Address of Property:
Mailing Address of Owner:
Owner's email: t'i/T/ � fi i11J%i�r4wner's Phone#:
Agent's Name:
Agent's Email:
Agent
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
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.U. urvtsron or coasrar
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 must sign
the appropriate blank below.)
1 DO wish to waive some/all of the 15' setback
Signa ure of Adajt Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO: o m t L. 5 4-M 4
Mailing Address of ARPO: !{M W U, 5L6W ,� /ce -a�P/ 7 "Y
ARPO's email: L ARPO s Phone#:
Date: 010015*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: A� Z / /7ZO�01 !
Address of Property: '� Akh &ZA/ S.( 0 tCJJ 4 n, 1mg/IwAlj, Ny 7 /// / r
Mailing Address of Owner: �r� �L�� '1�LU` t-tA�/ Ae,?' , `��
Owner's email iiA/ e Ow"nfs Phone#:
Agent's Name:
Agent's Email:
Agent
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
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 must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback �, _ ,/// _Z_
Signature of Adjacent Riparian Property 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:
Mailing Address of ARPO: / / 2)&/ :U
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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