89838A - Adams, Teresa and Harvey

a°t cog [ICAMA ❑ DREDGE & FILL N9 89838 A B C D
I GENERAL PERMIT Previous permit
Date previous permit issued
❑ New [MModification ❑ 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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nagov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
Authorized Agent
Project Location (County):
State ZIP '+' Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW HEW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body (nat/roan/unk)
AEC(s): ❑OEA ❑IHA ❑UW SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
e_—&I6 e_-tree�ntforvvt _ (Scale: )
Access Length
Pier (dock) length
Fixed Platform(s) r� _�_2V�
Floating Platform(s)fit
✓'�.,
_
r
',...
Finger piers) !hr
t, _._.. .. _
Total Platform area r
- -
%
_
ty ;.
—
(.�j
}
�.�
-
-
Groin length/a
i+a
Bulkhead/ Riprap length I .W�Nt, d -- _ - — - -- ----
Avg distance offshore
cEttTLCZ. ^�'
Breakwater/Sill
PR o��PasG-a -
—
_y_
—-
r
_-
Max distance/ length
Basin, channel O VO GK
Cubic
yards
}
y
Boat ramp
Boathouse/Boatlift� - •r
--i—��`
,_
Beach Bulldozing PROP• j
I
i
'j
Other T4
1
t—
ray
i
_
SAV observed: yes no)'
Moratorium: n/a yes no - �Gvt(ciY�1c wt"G
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Site Photos: yes no of eK`I
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: gE,'
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 backof permit'* Signature
Application Feels) Check q/Money Order Issuing Date Expiration Date
Nodf4icd 41Zs'*Pe`M%g4—

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NOTES: fir, sir !r =Y
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LAOOON�L��
83.00' �✓r.
SAR
LOT 23
)tic Layout Approved
Dare County
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Ed and Maryellen. Kunz .
Lot 22. elock 107, 8authoM Shares
bare Caunly
Atlantic Township Nvdh Carolino
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OATF: Aug-1 70. 400+ m
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
Name of Prope
Address of Prol
Mailing Address
Owner's email:
Agent's Name:
Agent's Email: _
(Top portion to be completed by owner or their agent)
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. 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.
it you nave 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, 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
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/ ty 0 1
-OR-
Signature of djacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Type(
Mailin
ARPa
Date:
,tic _V`ly`I
Revised July 2021

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)
Name of Property Owner. -
Address of Property: _
Mailing Address of Owner:
Owner's email: t° Y✓ y
Agent's Name:
Agent's Email:
Agent Phone#:
Co
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto 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
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' setbac —
Signature of Adjace-n rpanan 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: l l7�>o� •� 2
Mailing Address ofARPO: bcz�� uovleu-+� , #�Otoi S�,'r4 Sh+rS NCt%)�54q
ARPO's��.e//mall: ��Ib16z<-c� N ;�a(.r �.� ARPO's Phona#:
Date: 91,3d jd-3 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

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