87041A - Fawcett

�,,(butx, [ 11CAMA El DREDGE & FILL N9 87041 B C D
GENERAL PERMPT Previous permit
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!
ISA NCAC 111laet, ❑ Rules attached. In General Permit Rules available at the following link: vnvw.deencgov/CAMAmIes
Applicant Name L&" R' icls (.L` r
Address LI �Lls Sleapv Belt c: (zdtl
City St, UV_ _-State VN ZIP
Phone#()5) s' S9a'(�
Email Qr Cr'i 0o 09 yl'r•I C n>•�
Affected 0CW EW PTA 11ES [—]PTS
AEC(s): DOEA IHA HuW OSPIMA DPWS
ORW: yes y(fP PNA: ye�j
Type of Project/ ActlVlty _.Cyy,4r „c 4 Zoo & a„ r dJ
Shoreline Length 3 %0
Access Length __�
Pier (dock) length
xed Platform -10 '( I Its'
(
Floating Platforms) -
Finger pier(s)
Authorized Agent WE
Project Location (County): (�(;i C_
Street Address/State Road/Lot #(s) 311(o IVio�r L0F 614D
Subdivision j`Oor t5ls ol(]
City K,II NV' I zip '.]7-445
Adj. Wtr. Body k,i}y Rnw1C_ ()�.a d�PubarVunk)
Closest Mal. Wte Body AlibjyAtjlti mound
ti
AJ}Iv e. y.al CW6t(1 e1.�.\'I�1
� L`-ItOrAw I,S-S 7'A`
(Stele: IUJ'-� )
(A Ctts,v 65
`N v �cyctrVsr�
Total Platform area 3$`I S-jr Y. \'o
Groin length/ X,
Bulkhead/giprap length : �.O �•��
Avg distance offshore
Breakwater/Sill\
Max distance/length tL,'ys3'TI ^
Basin, channel
Cubic Vards_ (a.;tivt ' �Z
ZaP5c.1 p4..1-4e;•w
Boat ramp F5Av~ Psi pi \•L brH)I,Irt
Boathouse oath i3•Xt?; 4'etk. (,isrxlAr ekQyl.l 3s�
4eeek4liksaM(711�'Xid' L'1lJa Vtsr �•
Other 9F11C-�
SAV observed: ye no
Moratorlum:<55N5 yes no
Site Photos: �yqi no
Riparian Waiver Attached: �a no
A building permit/zoning permit may be required by: _ k,)_� `Z eLu \
Permit Conditions
_qL
FC,W Ls, I'I'
K),
Mc,banva
Lwat "(
11 TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
��dCL By tKLcv3L.yL
ApplicationFee(s) CbJt Jl/Money Order Issuing Expiration Date

*[PNew
[PCAMA [ADREDGE & FILL N9 87041 B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑ 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 7 R. ( a.00 ❑ Rules attached. rX General Permit Rules available at the following link: v w vdeq.nc.gov/CAMArules
Applicant Name JQSCr P• FawCCW
Address 4 a.3SS' S Ul %2y Mt- 20e,4
City sugGoly. State VA ZIP a34-s
Phone # (M) WUIT- S 4 S6
Email �PtVCfCc7o r[� gMa•I . Cs�n'a
Affected ❑ eW E W PTA ❑ ES ❑ PTS
AEC(s): ❑OEA IHA NUW SPIMA ❑PWS
ORW: yesep PNA: yetro >
Type of Project/ Activity Cw.S}r CA Roos, a� r ate,
Shoreline Length f gOt
Access Length
Pier (dock) length
fixed Platform r % I t
�I�uaSccy
Floating Platforms)
Finger pier(s)
Total Platform area 'A &'r'
Groin length/
Bulkhead/ Riprap length o
Avg distance offshore
Authorized Agent Ne, Prolrn._ C'iJfOe'fi-✓1
Project Location (County): (Ja rC
Street Address/State Road/Lot#(a) 311(a Say 0ritrlf L•01`11140
Subdivision Monr ShofCS
city KAI Wv,I I}i1U zip n}44�
Adj. Wtr. Body K I }A!q 1ia.. &,J �nan/unk)
Closest Mal. Wtr. Body /111wmeI h Su,^J
�- 1 \1 v
EI<�a1 r I,ys >'
a
t t,x fa.tr S. V,,,,
t3 �•'1 Max distance/length � r•�.t3t-sT 1 '^
Basin, channel
Cubic yards
Boat ramp t). k in
Boathouse oats' 13 At3 4•ytlt Cyp�rti�
BeeeM9nlld dtlii) 13 Al L=\tJA 1uf
Other Dot. r
SAV observed: ye no
Moratorium:<o/ yes no " �^
Site Photos: (:!72 no
Riparian Waiver Attached: a no
A building permit/zoning permit may be required by: K ,L
Permit Conditions
Agent or Applicant PRINTED Name
X
S gnature *'Please read compliance statement on back of permit-'
6400 . Do # 6086
Application Fee(s) rhar4 it/Money Order
aft CS
1ae %% (Scale: PJA j
LX �J�1Ghu.d
� urr \• —
N c.Cu.f.b\s
CV.AwNttf )
_AFL
II
Faw u4f
Q�Gt70.n�G
CWa.t-If)
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
STATEMENT. (Please Initial)
iila�lao�� 3�19�a.oaH
Issuing Expiration Date

��`°"" ❑CAMA ❑DREDGE & FILL N9 87041 A B C D
Previous permit
a 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:
15A NCAC -) h I \ ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name r,< , -. i2f C,,
Address
t
City,`Tr '. „ . State . I V. ZIP 7) 't. -i
Phone # ( y() %-` < < `,`;ref c. t..
Email
Affected ❑CW
AEC(s): ❑ OEA
ORIN: yes/no
i, EW ❑h' PTA
❑IHA ❑UW
PNA:
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s) -> i i, 11 IIJ,I
Subdivision )-i: 1,i -r
City k I k i\c l II;Y", ZIP
❑ ES ❑ PTS Adj. Wtr. Body V ,��_4 i2, t Pat/Tnan/unk)
❑ SPIMA ❑ PINS Closest Maj. Wtr. Body Ai1ajyjc.i l.-
i
Type of Project/ Activity QLn I , t : , or e r.. +>
L_ ar, t
Ir y k �1 R 1 k 4 F fu3e' I n (Scale: P1;) )
0
■1::::::::::::N
IN
Finger pier(s)�n..
..
�
n:■��
Romp
Total Platform area
Groin length/#
Bulkhead/ Rlprap length
Max distance/ length
Basin, channel
yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
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MENNEN
ME
M
No
II
1I::::::,
SAV observed: yes no: . _. _.yes_
Moratorium:mPhotos:
n.■:::::01N.
0
0
w■■■ni
:::::so
:
A building permit/zoning permit may be required by: Y 1\ S�edA
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#/Money Order Issuing Date Expiration Date

Name of Property Owner Requesting Permit � as • v � FAw cmtt
Mailing Address: L 1 a 3 S $ I { dP( k' l" ILJL •
a3'i3S
Phone Number: -7s-1 ay S
Email Address: . f �r , .rN G o ®' Mi► I • Qa^ "t
I certify that I have authorized N E 0.M+ w r
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: .� `� S 2
�-S 9-0kl tP 1 rr�
at my property located at 3 11 (.
in Q&A a, 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.
Prope Info atkn:
Signature
Print or Type Name
Title
0°I I o t< 12e-s-3
Date
This certification is valid through
Revised Mar. Z016

WV
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
Name of Property
Address of Property:
Mailing
(Top portion to be completed ay owner or their agent)
1i
Owners Phone0 so -- S?5-5g6 ( 0
Agent PhoneM
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Ownsrt
Lj3S
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
1tnt`` 2—t� -.-pputt, y cu2oKlto.wo.�on 'Sts�c uaie1 5Pbke
I DO NbT have ob1
e5olts to this pr2fposal. I DO have objections to this propose.
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. Grim St., Ste. 300, Elizabeth City, NO, 27909. DCM representatives can also be
contacted at [phone]. No response Is considered the some as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose onlv one
I understand that any proposed pler, 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 riorait revahnents). (If you wish to waive the setback, you must slurp
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback sZlda� 7� �Ynr
Signature of Adjacent Riparian Pr6perty Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: 41WX--too �77V (Z�.�jj/t�-t
Typed/Printed name of ARPO: rhm lyk; {01 /Tt�'�A/gQ514
Mailing Address of ARPO: y v10 11& t7-1 6ffAi4 I(IA-�- WOUAS W
ARPO's email: ARPO's Phone#: — ay ^ zv'e
Date: 1 `waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

xW
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
Mailing Address of Owner:
Agent's
or their agent)
23L(35
er tt n 22195
�wner'sPhone#: 1�' 1C".� 5tK- -10p
Agent Phone#:�-
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. 9
rug or `l. ho(I coons ui� �J
� ml3 oronosal. I DO have o lectlons to thi prof
If you have objections to what is being proposed, you must nary me nr.u. urvrsion of L oasrar
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 ozone
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of IV 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, yqu must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback/ Signature ofAdjacen iparian ropertyOwner
-OR-
I DO NOT wish to waive the ITsetback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO: dim t � \ V vi. �,,v V �
Mailing Addreaa of ARPO: �1 T Val D r y `..a-, 9x�eu � ( 0r �� g 'I �
ARPO'sem il: /&C, C i'N LI-&i4ARPO'sPhonefl: 2 "JZ Z�(o �174`�
Date: 1I 1 11 17 "waiver is valid for up to one year from ARPO's Signature`
Revised August 2022

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