89872A - Pamela Fritz Trustees

�o+O`te"r"r ❑CAMA 0 DREDGE & FILL N9 89872
Ay B C D
GENERAL PERMIT Previous permit
Date previous permit issued
s
❑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 ❑Rules attached. ❑General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s) '
Phone # O ..
Email
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no,:' RNA: yes/no
Type of Project/ Activity
(Scale:' )
CFnrolinc I onorF
Access Length
i
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Pier (dock) length--
Fixed Platform(s)
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Floating Platforms)
Finger pier(s)
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Total Platform area
Groin length/tl
Bulkhead/ Riprap length
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-�-±-_
_
-_
Avg distance offshore-% l,
-
--+
—
-
-
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Breakwater/Sill
_
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Max distance/length`—`
t
T
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--
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0
,y
Basin, channel
I
7
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-
+
I
Cubic yards
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—
Boat ramp
Boathouse/Boatlift
I
tl----
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%
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t.
-4-
Beach Bulldozing_-.
Other
TIT
SAV observed: yes nq
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Moratorium: n/a yes no
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Site Photos: yes.: no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
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** Signature
Application Feels)
Check q/Money Order Issuing Date
Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completedby owner or their agent)
Name of Property Owner: l21?Mi G/4 6 Pk / rZ+ Address of Property: 1`11 Bay, Breeze Lome do,4//+ oid nL D At`PY
Mailing Address of Owner: 591"e
Owner's email: Owner's Phone#:
Agent's Name: 14gde^ MQI-1 AL'r r C /Age//_nt Phone#: �� -,3) -&3j�
Agent's Email: ��C�enl/VIU,-,Af-Q `pr LrV10i
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
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.
✓ 1�W 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 (252) 26&3901. No response Is considered the some 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
V-
sigmlk7fAdjacent Riparian Property Owner -OR-
RECEIVED
I do not wish to waive the 15' setback requirement (initial the blank) 9CT t 9 2023
Signature of Adjacent Riparian Property Owner.
®GM -EC
Typed/Printed name of ARPO: J QRA
Mailing Address of�ARPr1O: 1 ?� F' / d3 fL2 e1 e .4-Ar) e- 14CV-TTzl?.O .al. (. z79yy
ARPO'spemail: J K-ZS1h ree �7a) rjw,4j r, ARPO's Phone#: 703 Cfe5- 74 ? L
Date: 0 o *waiver is valid for up to one year from ARPO's Signature*
Le4ic(ev1 t''LNatr m0— Revised July 2021
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RECEIVED
OCT 19 2023
DCM-EC
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