89864A - King

tour N° 89864
�.� OCAMA � DREDGE &FILL t�Aj s c D
Previous permit
? GENERAL PERMIT Date previous permit issued
FY-] New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Qualityand the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City
Phone#(
Email
State ZIP
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
ORW: yes/no ; PNA: yes/nd.
Type of Project/ Activity i
❑ES ❑PTS
❑SPIMA ❑PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr. Body t (nat/man/unk)
Closest Maj. Wen Body
r �
_ (Scale:)J,_
Access Length
I
�
�
Pier(dock)length
I
1.7
Fixed Platform(s)
�J
I
f
i
Floating Platform(s)
i
t
Finger pier(s)
—
Total Platform area_'
Groin length/it
...
Bulkhead/Biprap length
C
i
Avg distance offshore
-
�
-�
4
T
—
-----r-
�
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
i s
f
i'.._
I
Boathouse/ Boatlift
77
Beach Bulldozing
Other
-Y
i-
It
-Ti-
SAVobserved: yes no
Moratorium: n/a yes no
I
Site Photos: yes no
_
_
—
RinarianWaiver Attached: ves no
A building permit/zoning permit may be required
Permit Conditions
�C•.i A
❑ 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
Signature —Please read compliance statement on back of permit"
Application Feels) Check N/Money Order
Permit Officer's PRINTED Name
Signature
i.
Issuing Date
Expiration Date

'I:CL. .
oCT t 3 2023
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY VCM-EC
(Top portion to be completed by owner or their agent)
Name of Property Owner: -1
Address of Property:
Mailing Address of Owner: _� 5 +9M
Owners email. A i //f1 Owner's Phone#: �94� ( O�
Agent's Name: tPet Mrtri rtt t Tetc . Agent(
Phone#: c
f�SC
Agent's Email: ___1_� ��� `
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 forthis
earmit has described to me, as shown on the attached drawing, the development they are proposing. A
r!� 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 me tv.c.. u,v`u" ` �.
Management fDCMJ in writing within 10 days of receipt of this notice. Correspondence should be
300,
cmallto ontacted can also be
0 S. Tiffin t, Ste,
response iElizaseth considered the someCity, NC, 27909-
s no bjectiontives 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 scan
the appropriate blank below.)
100 wish to waive somelall of the 16 setback
Signature of Adjacent Ripa an Properly Owner
•OR -
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: r 1 L
Typed/Printed name of ARPO: t C, Wt�
((�� �e o�
Mailing Address of ARPO: I O O O r) A
D •ye
1 oa"
ARPO's email: M 1ke irt^ •�9ARPO's Phone#:
Date- 16 I 7,0 Z °waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

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OCT 2 3 2023
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RECEIVED
N.C. DIVISION OF COASTAL MANAGEMEN-OAT 2 3 2M
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
(Top portion to be completed by owner or
Name of Property Owner: l D yJ 0 L'�,k, i e
r 1C11
Address of Property:
Mailing Address of Owner: 1
Owner's email: tL,tq Owner's Phone#: a ` O/` I r7 CI
14d Agent's Name: IC erN ff—CAri °tee %J;lC- Agent Phone#:
Agent's Email:
ne. P J404rti-,cc
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 noury me rm,. uivision or t oasrai
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
waited 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
noted 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.) A /J
I DO wish to waive some/all of the 15' setback
Signature 63r7ldlacent Riparian operty Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: �% T
Typed/Printed name of ARPO: CAcir'PS " O �/61 r
Mailing Address of ARPO: �A� S �drP Pr i v-e
ARPO's email:. KCAL., Douse 041 Smoil. A PO's Phone#: 252202 CO53
Date: ZUOCT 2D23 'waiver is valid for up to one year from ARPO's Signature
Revised July 2021

RECEIVED
OCT 2 3 2023
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