89866A - Marjorie Harris (Revoceable Trust)

00—AR ®CAMA ® DREDGE & FILL
aw GENERAL PERMIT
N- 9 89866 B C I
Previous Permit
Date previous permit issued
® New ❑ Modification [j 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:
1 SA NCAC - I iA • 10 - ❑ Rules attached. [" ] General Permit Rules available at the f H W tg fmik: „c.gOvJrAtgp ula:
11♦'u�iCaJ'dR•�11+�Sa'A1�7- ��1.Y'3�1•..#! `a rr: . c� c-a ta�-v �u:a��.
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ri
City h{¢rymr81 ZIP &
Affected ❑ M © EW ®PrA ®Ps ®PTS Ad). Wtr. Body ITyArs ^'r 'rfF &wej (at inan/unl
AEC(s): EJOFA EIIHA E1uW E]SPIMA E]PWs Closest Mai. WtrBody
ORW: yes d PNA: yes/ 10D
Type of Project/ Activity
Shoreline Length ' /^ t f
Access Length
Pier (dmk) length
Fhred Platforms)
Floating Platforms)
Finger pierbs)
Total Platform area
Groin
Avg
Mu distance/length
Basin, channel
Cubicyards
Boat ramp ...
Boathouse/ Boatlift
Beach Bulldozing
�.
Other
SAV observed: - ``'` yes i .}
Moratorium: op yes no I r I'"i
Site Photos: no i- L
Riparian Waiver Attached: 1=.-4-i
A building permit/zoning permit may be required by:
Permit Conditions _
i J.
H
TAR/PAWNEUSF/BUFFER (circle one)
See note on back regarding River Basin rite
See additional notes/conditions on back
. waaa ae lie Rm mce ror Dili ec aMn'ri]NDIflONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please
Slgnatu *•Please read complianWsstatement on back of permit" Signature
fiy .Z'f l 9' q i X3 'Al /zy
Application Feels) Check#/Money Order issuing Date Expiration Date

®CAMA ® DREDGE & FILL
a GENERAL PERMIT
3
©New []Modification ❑ Complete Reissue ❑ Partial Reissue
N9 89866 ® B C D
Previous permit
Date previous permit issued
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:
P
15A NCAC I oo ❑ Rules attached. ® General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name 1
1 1w- or
% P M m-.,i
KQ-yoc c-)nkk I1'W f
Authorized Agent V 111"C' I I �l ry l
tt��
Address "7 �0
� _�
l:A'i�54
"6SS Rd •
Ent Plv.mS) 'e t
Project Location (County):
City V�Y' s�
Ql'<>yh
State Ya
zip 234b1
ttii
Street Address/State Road/Lot#(s) la 'Fy,
Phone #(,'J) 1oi55 —Y730 Jlo11 /�wkh�luw YW.
Email %1� i1 X 3 \O'K ne+ Subdivision & S
City k rcd zip 2' "iA
Affected ❑ CW NEW N PTA X❑ ES © PTS Adj. Wtr. Body A l L.Q 11 ( as nan/unk)
AEC(s): ❑OEA ❑IHA ❑AUW ❑SPIMA ❑PWS Closest Maj. Wtr. Body ''I'beLy.{t,4_ �p
ORW: yesc) PNA: yes/(Lb)
Type of Project/ Activity
Shoreline Length ( 1 1 f y
Access Length .J LN
Pier (dock) length �.
Fixed Platform(s)
Floating Platform(s)
ti
Finger pier(s)
Total Platform area '^ lk
Groin length/q
ulkhea Riprap length
Avg distance offshore
Breakwater/Sill ^
Max distance/ length ` yy'`o
Basin, channel''` a
Cubic yards I j
Boat ramp
I" 3
_ I Ic
Boathouse/Boatld[ �
Beach Bulldozing Z
$Other V
SAV'� : Moratorium:
observedyes
Moratorium: nQa� yes no C �
Site Photos: 0 no +
Riparian Waiver Attached: a nUL '1p
A building permit/zoning permit may be required by: l 'ey- I''kW-QJ -A
❑ TAWPAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
CRC
Agent or Applicant PRINTED Name
Permit Offirpr's PRINTED Name
❑ See additional notes/conditions on back
(Please Initial)
Signature *'Please read compliance statement on back of permit** Signature
Application Feels) Check tt/Money Order Issuing Date Expiration Date

'�`°"'"r,�❑CAMA El DREDGE & FILL N° 89,866 A B C C
GENERAL PERMIT Previous 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent If
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body i' (nat/,man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
ch—lino i anohh
Access Length
i
�(:-
-
-
4
i
Pier (dock) length
__
_y
Fixed Platforms)
I
r
\,
I�.
7
'-
�
�
�
I
_
_
_
--
_-_
Floating Platform(s)
�
_
-
I
)
I
1
I
1
Finger pier(s)
_
L-
fF-
-
Total Platform area -
Groinlength/H
Bulkhead Riprap length 1
Avg distance offshore
Breakwater/Sill
-{-
--, j
- -
-�-
---
-i--
-
❑
i._
Max distance/ length ,' I
.`I_.`
�$
1
-❑
�-
v
[
I
-
-
-
,,,
Basin, channel
Cubic yards
1
,/
Boat ramp
-
Boathouse/Boatlift
T"
Beach Bulldozing
-L..
i
r_
❑�
-
a�
v�i
Cl_
Other
SAV observed: yes no
Moratorium: In yes no
-
!-
-
-
..I__
Site Photos: yes no
-
Riparian Waiver Attached: �. yes no
I.
- '__
A building permit/zoning permit may be required by:'�``�i
I
Permit Conditions
❑ TAR/PAM/NEUSF/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 I
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check p/Money Order Issuing Date
Expiration Date

1�
(/� @NoR
0 DE
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor dames H. Gregson, Director Dee Freeman, Secretary
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Date: /?c
---
e.
Name of Property Owner Applying for Permit:
Mailing address:
I certify that I have authorized
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of E & al
at my property located atr
This certification is valid through
Property Owner's Signature
�\f>' %c zl /Kai tb/ l r
Print or Type Name e�
Telephone Number
1367 U.S. 17 South, Elizabeth City, North Carolina 27909
Phone: [phone] \ FAX: [phone] \ intemet: www.nccoastalmanagement.net
An Equal opportunity \ Affirmative Action Employer- 50% Recycled t 10% Post Consumer Paper
(date).

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:
Address of Property: Jrv`i,yilov� ��
Mailing Address of Owner:
Owner's email: yl,i{I x 3 Owner's Phone#: [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
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
0
Signature of Adjacent Riparian Property Owner: 1 L 7<1�, ,�
Typed/Printed name of ARPO: / L— ,/2y-6e
q �1) 2 -7 ij
Mailing Address ofARPO: �5(�) (.t/';�,��Uot� i2,o�K ia��f��rzi) ��- �-
ARPO's email: ARPO's Phone#: 1 — 2y`�_5
Date: r " 2c2i *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

l'
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V

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:
Address of Property:
Mailing Address of Owner:
{ A. P � ,-? to
`A", 1JVl v /ovvl h7
Owner's email: IV+ A 3 nit 1 Owner's Phone#: -75 7 -b i'S "17,3()
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 15from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you h10 waive the setbac/ you must sign
wi
the appropriate blank below.) /
I DO wish to waive some/all of the 1
Qi]0
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
Mailing Address ofARPO: I /✓ol a :S 7-
ARPO's email: «{�� `�}E'^IO-�Le���' ARPO's Phone#:
Date: 4 i 7 ? *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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