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Home My WebLink About89873A - Proctor❑CAMA ❑ DREDGE & FILL N9 89873 A B C D GENERAL PERMIT Previous permit 3 Date previous permit issued M 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.deg.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 ZIP -' Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Adj. Wtr. Body ,.r (nat),man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no% PNA: yes/no Type of Project/ Activity (Scale:4 Shoreline Length Access Length f :— Pier (dock) length Fixed Platform(s) - 's Floating Platform(s) -- LIE j Finger piers) Total Platform area Groin length/q Bulkhead/Riprap length 1 Avg distance offshore Breakwater/Sill `- Max distance/ length Basin, channel Cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other SAVobserved: yes no �� f� ft J" Moratorium: n/a yes no Site Photos: yes no J _ — Riparian Waiver Attached: yes no A building permit/zoning permit may be required hy: ��' 0 t rls[i. /y) (' cot . r�� :d 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 Signature *• Please read compliance statement on back of permit" Application Feels) Check #/Money Order Permit Officer's PRINTED Name Signature i t Issuing Date Expiration Date N.C. 01VIS)ON Of COASI AL MANAGEMEN'T ADjAr-ENT RIPARIAN PROPERTY OWNER No I IF 1CATIONIWAivFR F014M P, t lol� flo�,,00 to WO" "' (06 1-6 1� 13e �'in 91, 4; Li c-1 U 13e. U A '2-3 `t C-, I -I A ",mbi oeftly ftk I own ProPettY adlbUtatl 10 the awvii T&,Sfiqw�o 0, ��csti�,osd9r 7 t DO NOT hAve to th,s P1000 �A' •ff) tryov ")AV# 0tvactions to What IS Doong pmfto's', you'""' Manaq,nhinf (DCMo to wrantg w4hin 10 dJY5 of lvai:Wpf at ujhI j,04,,co CotespondoorIv ,rij,fed ro 401 S. (,rnyon St, Sto 300, Ebzabath City, NC, 271M, CCM MP(85*0hiti�" cap 41yo bu, cVMAC%kfcf zfi, 1 :1164 3001 W, rosioonso 's convu,Vj blosumo as no onjocvno it you ha"o boon Ill,'Idied by ct"*t�0,1 Mad WAIVER SECTION (Choose i nL,_ntt, ,aderstario mat any prwsediowr axk, -caring 04', ,�.p �, bp,)rwalf;'� orcin must tw Set 004* a m-tur"Um d,f,,a of 15' -Ij �. m +,na49�1rs L�2��ILXM+I V-, A 1; --t bhiartk below I DO wfsh to wa! ve &omesii of tht, 15 PE-CE -OR- fDO NOT wish to waive the. li'sathook (equoigiYient (Iptiaj tile ejank) Sigoatura of Adjar-PMRI i!moa Pmpzttv Owntr TYPedlPhott-d tisioa 4,4vig Adu, %ts of A RR0,-dz11—AZ-�Qs OCT 2 0 L91 AN M1, 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) C- c, t F %c 1 y c.. d'Ae l c /L- Name of Property Owner: r Address of Property: �b�o t;on/� %'act �� ff�, /Vc. u�1 Lr1'k9 !"'�`ii Y'iSc�„`-� Mailing Address of Owner: U Owner's email: .. rk loOwner's Phone#: � � �" � 5 b 3 y 10 k, y L3 Agent's Name: Agent's Email: Agent 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 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) 264-3901. 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 to bulkheads or rigrap 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 C Gs G Signature of Adjacent Riparian Property Or�ri�rL-• -OR- OCT 2 D I DO NOT wish to waive the 15' setback requirement (initial the blank) �ryyp�nfln t.lCM- N LJ Signature of Adjacent Riparian Property Owner: `—a Typed/Printed name ofARPO: c�h'6Z-5-^j L/C- Mailing Address ofARPO: 73v0 /YI S"nvIs�C ARPO'semalI:S7cVr s,a,0) ARPO'sPhone#: iS7 %?P-2dl Date: / 0 • Z. 7 3 *waiver is valid for up to one year from ARPO's Signature* Revised August 2022 l�, b” RECEIVED OCT 2 0 2023 DCM-EC � rn v>