89895A - Houser

divow° MCAMA ❑ DREDGE & FILL N9 89895 CA) B C D
fA GENERAL PERMIT Date Devioupermit
Date previous permit issued
]New [I Modification El Complete Reissue ❑Partial Reissue
As authorized by the St to of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC 1 /?' Diz>
r=A❑ Rules attached, eneral Permit Rules available at the following link: wsvwdeo nc gov/CAMAroIes
Applicant Name fi 1 C K `, c5 ti Q-r f" `/ /-}otk--
Address 13 ct c- I o .,, Zan �
gtat+ Ifa� I s�� zIP�) .s7y (o2 ff �.sr; I•c/ / @ Ccs�S'1-i rl Z: p1 s1 7 CI�2 ;-/ Irl i� t:..eM Cts .S -i'; nc-�-'
Affected ❑CW BEW 0�14A ❑ES ❑PTS
AEC(s): 00EA ❑IHA ❑UW ❑SPIMA ❑PWS
PNA: yes/no
Type of Project/ Activity
Authorized Agent /. _) il-- //1 e\ C-1 /L JZ L p r) 5;C'-
Project Location (County): Q c�C'�
Street Address/State Road/Lot #(s) /- ks
Subdivision ;•..
I ; -(-f /+&.I I� 63
city _ /k l f j j / a.,w / c
Adj. Wm. Body CA OA L-Or e4l, ON d 4�-
Closest Mal. Win Body C w � I, c�
' 7 5'Y 9
5 o.I ,l d.
Shoreline Length
(Scale: � S )
/ O � . - V •' � r — t/ --s/ �" v
Access Length
Pier (dock) length
Fixed Platforms) r
Floating Platformis)
Finger pier(s)
Total Platform area
Groin length/g
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill "-
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp '-
Boathouse/ Boallift
Beach Bulldozing
Other
4
SAV observed: yes on] I
�: n
Moratorium: n/a ye no V V
Site Photos: yes no V
Riparian Waiver Attached: cr£
A building permit/zoning permit maybe required by:
`//
❑ 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 PROJECTAND REVIEWED COMPLIANCE STATEMENT. (Please Initial)�L
Monica I M Rmnil
Agent orApplicant PRINTED a
Sign lure'•Please ( compliance statement on back of per;wlt
9E t; 3111
Application Feels) Check g/Money Order
Ivonn� .mily—
Permit Officer's PRINTED Name
Sign I
re
01
Issuing Date Expiration Date

❑DREDGE & FILL
1G''ENERAL PERMIT
❑Modification ❑ Complete Reissue ❑ Partial Reissue
NO 89895
Previous permit
Date previous permit issued
(A) B C D
As authorized by the 5 to of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC t /'�" ❑ Rules attached. a eral Permit Rules available at the following link: www.deq.nc.&oy/CAMAruIes
Applicant Name /l r C q' t, r r Authorized Agent G c- S rlk �^
Address -5-/L.3 5 13 Cam r 1 0 0. n 2 p Project Location (County):
City /<State C-- ZIP 2.% `% `� I Street Address/State Road/Lot #(s) L. b 3 ) T
Phone#() .S �%� (o5 Z2
Email A2.'Z �f'N �@Co/K G6,-s Tr r12 Subdivision
�t Cke. C—1 rt /r7 a Ca M c,.54; n. A- City )J ZIP �Z-'l?Y cl
Affected ❑CW Q]6W- 21-PU ❑ ES ❑ PTS Adj. Wtr. Body C, tJA L 'a3Yt d `z- Crr -/< na an/unk)
AEC s : lI��II OEA IHA UW SPIMA PWS �c�� �. -Soy,. `(-
() � ❑ ❑ ❑ ❑ Closest Maj. Wtr. Body �- c-c-1 (` �
ORW: ye no PNA: yes/no y /�
Type of Project/ Activity C 3 /n S "I r'�.. c,� 2- L4 ! `�'-4 Ci+'�
✓(Scale: 1(6 )
Shoreline Length / 0 � �-v -� J/ 7 — � "r�
Access Length
Pier (dock) length
Fixed Platform(s) rZn J�-
Floating Platform(s)
Finger pier(s)
Total Platform area �-
Groinlength/q
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel Cubic yards -
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
4
/� s i
SAV observed: yes L'D
Moratorium: n/a yew no �1
Site Photos: yes nQQ V
Riparian Waiver Attached: s /nd
A building permit/zoning permit may be required by: b
Permit Conditions
FA
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial
"/Vonna- �o{J<"
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name /
Sign ture -'Please read compliance statement on back of permit" Sign t re
�o�li
Application Feels) Check q/Money Order Issuing Date Expiration Date

Nv 89895
��`°"u ❑CAMA ❑DREDGE & FILL
a 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:
15A NCAC ❑ Rules attached. '�-Tie`deral Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name ` '% H of -S c Authorized Agent i .' j C 11 { I Z ri S I Y'k c-�-t
Address -r' ' Project Location (County): CS,
City (�. State zip / �] `� i Street Address/State Road/Lot #(s) -t
Phone # (' ) .,' / ,3 _`>
Email J7 'Zi" i
Subdivision
City k(4 ZIP
Affected ❑ C W ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body ' i,- -
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: ^ )
Shoreline Length y c' '
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 _
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
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 re
Permit Conditions
❑ 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 lnitial)�e
Agent or Applicant PRINTED Name
Signature *`Please read compliance statement on back
Permit Officer's PRINTED Name
Signature
n I !
Expiration Date
Application Fee(s) Check#/Money Order Issuing Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: ___ SL
Phone Number: .!.?_sue --------------
Email Address: _ 10 _CQrn[��iL_rZe{__�1�G]�� 1��f1✓� cash Ai�
I certify that I have authorized
Agent/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
new 8' x 24' dock
necessary for the following proposed development: ___________________________
at my property located at _ �7r13 Jr Lar JQw �yl _1�J i ! _C -�+ �9
in gy__2 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
Date
This certification is valid through ------J__-___-/

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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: RICKY & SHERRY HOUSER
Address of Property: 5135 BARLOW LANE, KITTY HAWK, NC 27949
Mailing Address of Owner: 5135 BARLOW LANE, KITTY HAWK, NC 27949
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Scott C Small Agent Phone#: [phone]
Agent's Email: [e-mail] / [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adlacent Property Owner)
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
descrintion nrdrawlnn with ti_ ...... ,
I DO NOT have objections to this proposal. I DO have objections to this proposal,
o you nave 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 ff 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
-OR-
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: LISA F BARNES
Mailing Address of ARPO: 5127 BARLOW LANE, KITTY HAWK, NC 27949
ARPO's email: 1
L C� d )' U IARPO's Phone#: A1jr,�i�
Date: .J 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

DocuSign Envelope ID: DFA04F20-42DD-49DA-BCFE-A1F392DC06D2
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: RICKY & SHERRY HOUSER
Address of Property: 5135 BARLOW LANE, KITTY HAWK, NC 27949
Mailing Address of Owner: 5135 BARLOW LANE, KITTY HAWK, NC 27949
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Scott C Small Agent Phone#: [phone]
Agent's Email: [e-mail] / [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adiacent Property Owner)
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
descriQljon or drawing,with dimensions must be r v'ded with this letter.
x I DO NOT have objections to this proposal. I DO have objections to this proposal.
It 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
malted 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 riprep 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 •,�.•„
-OR-
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: DAVID T & PATRICA A LUSK
Mailing Address of ARPO: 5241 BARLOW LANE, KITTY HAWK, NC 27949
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature -
Revised July 2021
1-1

Carver, Yvonne
From:
Sent:
To:
Subject:
Attachments:
Good morning Monica,
Carver, Yvonne
Thursday, October 12, 2023 8:22 AM
Monica Small ([e-mail])
HouserGP89895
HOUSER GP89895-10112023172223.pdf
A copy of general permit (GP) number 89895 for the Houser dock project in Kitty Hawk is
attached. To validate this permit, please address the following:
1. print and sign the permit on the bottom left-hand corner below your printed name,
2. initial where indicated on the bottom right of the permit, and
3. scan and send a signed copy of the GP back to me.
No work can be initiated until after we receive the signed copy.
Please let me know if you have any questions.
Thank you,
Yvonne B. Carver
Environmental Specialist II
Division of Coastal Management
NC Department of Environmental Quality
252-264-3901, ext. 237
1

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