89861A - Thomas

�.� dNp " (9�,CAMA LI DREDGE8t FILL N° 80861 Q a c C
A9 GENERAL PERMIT Previous permit
Date previous permit issued
X New U Modification [ ] Complete Reissue L] 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 r7' i! 2 c�% Rules attached. ® General Permit Rules available at tiro following fink: vzww.dey_nc.govJGAMArules
Applicam Name C C.rS i ki
Address 3'Sifj� i%rc.Tn.lig+e tc
City �_%kk State NC. Zip a I�s7
Phone #(2!5j) 3a5-yt�JROO2
Email f,I ' n An �1l(Y2 hcs '@ CZ mct F I r cein
Project Location (County):
Street Address/Staua ��qqW/Lot #(s)
33 ! ertlti}-aFie Rd.
Subdivision '—"" t �t
City 1yr enrl,f t- t) ___ZIP___a..
Affected 0 CW ® EW YPTA ❑ ES ❑ PTS Adj. War. Body _ U"LA.)OL 1 l-.t rle. (4k,4tJ�aan(unk)
AEC(s): I1 OEA 0IHA (] UW ❑ SPIMA ❑ PWS Closest Mi. Wtc Body �imotr Q�'
ORW: yes/le) PNA: yes/e
..,_ ...
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Fingerpier(s)
Total Platform areao�5.__ .. �. _ _ .A.�C4..
Groin length/tl
Bulkhead/ Riprap length
A distance offshore - A`" - sV,Y.i➢" _ ; �,ia`4 oaet
Breakwater/Sill
Max distance/ length Q
Basin. channel ^ , .�------
Cubic
yards
Boat ramp
tathou Boatlih
e e ptldozing,_
Other__ .. . o-'S _
t„as
SAV observed: Yes �j .._._ .�.
m
Moratoriu� yes no
Site Photos: a no
Riparian Waiver Attached: Q-1D no_./;^ ``__i
A building permit/zoMngpertnR maybe required bir �ear� tUtA4.r. -
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 11F W19d gijtliSAND CDNDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Pleaselnitial)
Permit
S" ature"Please read compliance statement on back of permit*- .2 Signature•
ApplicationFeels)Check P/Money order Issuing Date Expiration Date

y; tauq N° 89861 B C D
®,CAMA ❑DREDGE &FILL O
$ Previous permit
3 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 7 ( r 1 olo ❑Rules attached. ®General Permit Rules available at the following link: www.de .nc yov/CAMArules
Phone # (25S) 5a5 - doa.Z
Email Y05C rtv-4x')N ifyt� C` Q Q'hCS mcl; CQ W1
Affected ❑CW
AEC(s): ❑ OEA
ORW: yes/0
©EW ®PTA
❑IHA ❑UW
PNA: yes/Oo
of Project/ Activity
Shoreline Length 7—
Access Length I
(�
Pier (dock) length 0 t XrJ '
Fixed Platform($) )LI' )( 80 r 2
Floating Platform(s) —
Finger pier(s) i a S r X 3
Total Platform area�-
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin, channel
Cubic yards
Boat ramp
oathous /Boatlift as r X13,sr
Beadozing
Other _.
❑ ES ❑ PTS
❑SPIMA ❑PWS
Authorized Agent Q LC.
Project Location (County):
Street Address/State Road/
Subdivision
City
Adj. Wtr. Body t.rVOIAIX&A tit r-e. a(jVnan/unk)
Closest Maj. Wtr. Body CV M(Xt (Q_ -w
�"t a 1('0t Xsr GYii/t— W�lyrX
' X 13•S' bo0.the�ae _
scp�
%41<
I it, n
SAV observed :'� yes (:a $
Moratorium: yes no
Site Photos: 50 no
Riparian Waiver Attached: ® no t� 1
A building permit/zoning permit may be required by: l'lPrr1w
Permit Conditions
OF
Agent or Applicant PRINTED Name
(5cale:l*=5lb )
eN
i-6
114ACep
,
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
COMPLIANCE STATEMENT. (Please Initial)
Permit Officer's PRINTED Name
Sig atu/^r ',^ Please read compliance statement on back of permit""�.` .t Signature l'
OfC.t�•
Application Feels) Check #/Money Order Issuing Date Expiration Date

AMA ❑ DREDGE & FILL N9 89861 A B C D
a Previous permit
GENERAL PERMIT
s 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 i ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeq.nc.gov/CAMArules
Applicant Name
Address
City - State {i ZIP
Phone # ( )
Email i
Affected ❑ CW ❑ EW ❑ PTA ❑ Es ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no) PNA: yes/no
Type of Project/ Activity
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale: )
_....._.. _ __..e...
Access LengtFi
—
,
,
I
-�-
_
♦ _
''
T
c
_ }
—
-
Pier (dock) length
I
Fixed Platform(s)
-
;.—
-
-
Floating Platform(s)
I_
-I(
Finger pier(s)
_
I
L
—
--I
--
Total Platform area
Groin len h/N
'r
,
Bulkhead/Riprap length
Avg distance offshore
-
-
_
Breakwater/Sill
I
j
,��1
Max distance/length
1
Basin, channel--1
-
Cubic yards
"'
•..
r^
--
-—.
II
_
Boat ramp
Boathouse/Boatlift
I
I
rr
Beach Bulldozing
Other
.��
I
t
SAV observed:. yes no
=.•
-
I
I
-
-
Moratorium: n/ayes no
-`-
I
-
J
4+1
Site Photos: yes. no
1 -
—_„i
- —l.
_.__
__
-
_
_
Rinarian Waiver Attached: ves no
_
A building permit/zoning permit may be required
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**
Application Feels) Check N/Money Order
Signature
Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Mom gQl -,f n� �rlOrriaid,
Mailing Address:
54
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:
w
a 4' x 4, fo"
at my property located at
in [')Qllt& County.
q5'X 5' ,1b'x!4'
�nol, d- 3'X 13'6" wa>Z.Ict.>Jo.a.
l furthermore certify that l 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
R.asatiu,v. �.
Print or Type Name
�%Ow"-vw K -v
Title
I Z`1 / 23
Dale
This certification is valid through
OCT 0 2 IR3

N.C. DIVISION OF COASTAL MANAGEMENT 9" -C e E I V
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY 0 C T g 2 2023
(Top portion to be completed by owner or their agent) g� ,
Name of Property Owner: tAxVcus �+kusav�vn `(�ol�a5 � iV m g
Address of Property: 37.49 rityYvti}nqc RA, tAjtyv� (l I�G
Mailing Address of Owner. Sa wu.
YoeAw,AScl?
Owner's email: CIMAii. c- M Owners Phone#: [phone]
JR Mitt"!50w.
Agent's Nam: 0ae4w<SI o{a- 6o" t},y ^ c" Agent Phone#: Z52 - ';12 -'4 -1-4 4'
Agent's Email: r oo+}rAc iroYS A qWt rtn evrn
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.
V' I DO NOT have objections to this proposal. I DO have objections to this proposal.
H 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 (Choose oniv one
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
the does not apply to bulkheads or riprap revetments)- y h to vet k, you must sign
the appropriate blank below.) %�
I DO wish to waive some/all of the 15' setback
Signature ofAdfacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO; LQwKAN WVoA rP-Y i4-K
Mailing Address of ARPO: 311 a v e <d Mt-e r ITI1 Lie- -1 S 7
.�.�+-1cs5 nvN7Sl�
ARPO's email: avvwi I. c.o Vm ARPO'S Phone#: '2S 2. 333
Date: A . 3o • S3 'waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY OCT 0 2 2023
(Top portion to be completed by owner or their agent)
Name of Property Owner: to ofy e v5 � ?=e"rn ' (1�o vtisAS
Address of Property: 334 1 t< v wt i } . q c ?e(
Mailing Address of Owner: Sawu-
yw" 14 mw MASGm
Owner's email: ck i . cArn Owner's Phone#. 25 2 32S •Zoo 2
J9- t✓1itt+g^4^
Agent's Name: (o-•h•nc"L-s Agent Phone#:2G,2•;12_4-14A
Agent's Email: &-orgy
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 (Choose only one
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 io bulkheads or riprap revetments). (if you W warack. You must sign
the appropriate blank below.)
1 DO wish to waive some/all of the 15' setback
Signature of Adjacent lRiparian Property Owner
-OR.
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Q!eI�
Mailing Address of ARPO: 311 a v <d M. r r M11 N G Z'1 S '7
,�rYtcSS nor V4{SC�
ARPO's email:'pgji 1 • Lq m ARPO's Phone#: 25 2 3?,3 2 i
Date: 'waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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