89883A - Welling

@REDGE & FILL N9 89883 B c D
Previous permit
3 G E N E L PERMIT Date previous permit issued
few ❑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 �H • ,f o'd 9� /'I-- An' .0 ❑ Rules attached. >�eneral Permit Rules available at the following link: wwwdeci.nc.gov/CAMArules
Applicant Name 2 s • Authorized Agent
Address 3 % V
CZJ At d�Q�tQc-- 00. <L
Project Location (County):
� <3 - �
City 610—tZ hlr JGrr-tate� ZIP�3y
StrreeetAddress/StateRonad/Lot#(s) Sh//
Phone#.(SFa) (a
oL4 - /y73
—T do99 l�
Email ru. Q.A1'
A4 m "Le- tj$.
Subdivision Pt't-�-
A'10
City Ay b
ZIP 2 7 9 75
Affected ❑ cW
D?�W [tM J;M [O�WS
Adj. Wen Body C-a///�
C. man/u ( (na k)
AEC(s): ❑OEA
❑IHA ❑UW ❑SPIMA ❑PWS
Closest Maj. Wtr. Body
Po..M I r CD S Q Lk
ORW: ye no
PNA: ye no
Type 9f Project/ Activity C 0 A Jr4- rwr✓T
I xl"f 'Do ..s-..11- - $/x
Shoreline Length I 5 6'
Access Length
Pier(dock length A— / cQ '
Fixed Platform(s) X ' 74- X y
Floating Platform(s)
-kv s-yI -mod y' 7t-xq a"ec�k
Finger pier(s)
Total Platform area �% 1
G h/!f
Bulkhead Ripraplength js.
Avg is ante offshore �. d
Breakwater/Sill -�
Max distance/length
Basin, channel e
Cubic yards _ .y
Boat ramp '~
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: no
Moratorium: n/a no
Site Photos: es no
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by
Permit Cor)ditions
THAT
W EG L/ NG
/
PRINTED Name
14
Y (Scale: NT1�1
wll�war)
C�
/J 9t
44C&
wcry
TAR/PAM/NEUSE/BUFFER(circle one)
ElSee note on back regarding River Basin rules
See additional notes/conditions on back
(Please
Sig/nature **Please reacrcompliance statement on back of permit** Sigo')ure / /
load /��.3 /Dl/'J%23
Application Feels) Check H/Money Order Issuing Date Expiration Date

❑CAMA ❑ DREDGE & FILL N9 89883 AB C D
GENERAL PERMIT Previous permit
m 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 I
Address _
City
Phone #
Email
ZIP
Project Location (County):
Street Address/State Road/Lot #(s)
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORIN: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length _
Pier (dock) lengtf
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/ Boatlift
Beach Bulldozing
Other
SAVobserved:
yes no
Moratorium: n/a
Moratorium:
yes no -iP
-f-x-
tv
Site Photos:
yT
R
RiparianWaiverAttached:
y
A building permit/zoning permit may be required by:
Permit Conditions
(Scale: ' )
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 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"
Application Feels)
Signature
Check F/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
%Ve uJ /`/ i I (9-0fZ
Phone Number:
Email Address:
I certify that I have authorized
5 A(
Or
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 0 v ( jc lit e a A 4- 0 oC-k
at my property located at 1-1 o U g ol R e e b mt� Vo r, ,/V� 27, 9 6
in Do K County.
I furthermore certify that I 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
Roaerz GJe�II:-tS:�
—� Print or Type Name
Title
iU I )4 I "43
Date
This certification is valid through // 1 /7 l -?, 3

1
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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 U `)-4 Z W Q
Address of property 0 0 y P/ (?-e e s- 0 r2 " � Va /y4-- % � l �'
Mailing Address of OwnerO Bu^ J g 3 '>o C" G 2- 7 2/
owner semail: p,jj_gtOwner's Phone#:.S 70, 60Y /`i
Agent's Name: -- - _ _—. -.. Agent Phone#: _
Agent's Finan.
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIRCATION
(Botlp n ip rtion to be corn leted by the Adjacent Property- er
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.
v/ I DO NOT have objections to thls proposal. - I DO have objections to this proposal
if�yrou have objections to what is being proposed, you must runty the N.C. Division of Coastal
Manayernent (DO" in writing within 10 days of receipt of this notice. Correspondence should be
marled to 401 S. Griffin St, Ste. 300, Elizabeth City, NC, 27909. DCU 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 16 setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15 setback requirement (initial the blank)i_..
Signature of Adjacent Riparian Property Owner: 1 CiKl i
Typed[Printed name of ARPO:
Mailing Address of ARPO: —T-_X_D0q ARPO'semail:bY1e 'iC�S r sF- ARPO'sPhone# 541�- `
JA'--aOy
Date: iQ 'r Qa -waiver is valid for ao to one vnar fmm ARPn'c Rinnnhem*

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL . RETURN RECEIPT RE UESTED or HAND DELIVERY
(Pop portion to be completed by owner or their agent)
t ,
Name of Property Owner: , , 0 -e � {�`) *° �^ �
Address of Property: 7 9O f A� 4 - o a A ion
wn
Mailing Address of Omer; f (! o 3 0 3 ' Vo•^
Owner's email: V' w � �'
�t ne�.nef Owner's Phone#:
Agent's Name:
Agents Emair.
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be comploted by the Adjacent PropertV Owner)
I hereby certify that I own property adjaceritto 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
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, Hlzaboth � me asMoO Ib's at atives can fi you have been
be
contacted at [phone]. No response is c�
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, IA or
groin must be set back a minimum distance of 16, 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 s
lag
the appropriate blank below.)
I DO wish to waive somaiall of the 15 setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) ^.
Signature of Adjacent Riparian Property Owner.
TypediPrinted name of ARPO•
Mailing Address of ARPO: 1--7086y
a79V�
ARPO's emall: b e- O's Phone#: TO 34a
Date: /491I J / 2,6?3 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

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