89851A - Broaddus

'oIN 0LOW, & FICAMA ❑ DREDGE & FILL NU 89851 A B C D
I GENERAL PERMIT Previous 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:
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
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot#(s) ,,t lrni 14 l
Subdivision
City
Affected ❑ CW n EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: N,' )
Access Length--
._
Pier (dock) length
lat
rt
Fixed Platform(s) r - T_
-
-
--
-
_1-
---
Floating Platform(s)
Finger piers)
t)_�C•-
I
-
Total Platform area
v-
`
t-
Groin length/rt
Bulkhead/ Riprap length
Avg distance offshore i i
Breakwater/Sill - J-
I
-
--
{--
-
-
-
.
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t
-
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-
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r.
s
-
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Max distance/length
-
-
-i-"
IN
�+�
Basin, channel
Cubic yards7-
Boat ramp
Boathouse/ Boatlift s
Beach Bulldozing •,
Other
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l s
1
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-
W-j^
V
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ry
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SAV observed: yes no
Moratorium: :n/a yes no
Site Photos: yes no
Riparian Waiver Attached: -,; yes no
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-
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A building permit/zoning permit may be required by: 011, ')y
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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
(Please Initial) J_
Signature **Please read compliance statement on back of permit•"
00's
Application Feels) Check M/Money Order
Signature
Issuing Date Expiration Date

D CAMA El DREDGE & FILL N9 89611 A B C D
Previous permit
ENERAL PERMIT Date previous permit issued 1�
E]New FlModification []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 cone rsuantto:
15A NCAC — n Rules attached. General Permit Rules available at the following link: www.degmc.gov/CAMArules
Applicant Name
Address
City I", v", 4-l"I State ZIP
Phone # (a"2) C-i
Email
Affected F-1CW
MEW
11 PTA
nES OPTS
AEC(s): F-1 OEA
F] IHA
0UW
❑SPIMA E] PWS
CNRW: yes/no
PNA: yes/no
Type of Project/ Activity
V
1 2'X 12' L
Access Length
Pier (dock) length
6xeci,01 rm(s) atfo 4 14
Floating Platform(s)
Finger- pier(s)
Total Platform area
Groin length/#
head?. Rprap length
di'stance offshore , J
Breakwater/Sill
{Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Otte X
Beach Baecalar"), I d-", 1 xr ii
SAV observed: yes 11-0)
Moratorium: yes no
Site Photos: �yes' no
Riparian Waiver Attached s no
Authorized Agent
Project Location (County): It tr
Street AddreWState Road/Lot #(s) Z
Subdivision lu-W,,-; R-e Vi/vb �J
City i1,-A d [?.g-", zip
Adj. Win Body YJ 4' a ,
Ld in t/6arvunk)
Closest Maj. Win Body t-,J "o, - ', L'. t",
I
(Scale: I
-
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F-1
It
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I -
I
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7
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61
4
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A building permit/zoning peimit may be required by:
Permit Conditions
A9 ent or Applicant PRINTED Name
_
Signature '*Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
at!
[:] TAR/PAM/NEUSE/BUFFER (circle one)
F] See note on back regarding River Basin rules
E]See additional notes/conditions on back
ID REVIEWED COMPLIANCE STATEMENT.
(Please Initial)
Permit Officer's PRINTED Name
Signature
Issuing Date
E41ration Date

DIVISION OF COASTAL MANAGEMENT
AGENCY FORM FOR PERMIT APPLICATIONS
l (�Gio,1-4J Al /fFrc de c%✓u s J��, owner of the property located at:
(property owner)
(prope`r'tylocationladdress) ' %
(property location address)
do hereby authorize �P`f i4d t la
(name ofperson or company acting as agent)
to act as my agent for the purpose of obtaining any required CAMA permits that may be needed
for the proposed development at the above -indicated property. My project entails:
kt�
r
proposed development for which permits are being sought)
This agency authorization is limited to the specific activities described above, and will expire on:
(date on which agency authorization expires)
(signature) r (date)
lC r "t/. �ie.o.,.��., �J`�-- :� S'Z — 3 evS" S'! 3 d
(printed name ofownei) (day-timephone number) (title, if officer of core. owner or trustee for property) R E C I `��{
E D
MAI 3 U 2023
DCM-EC

i
1 DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner.
Address of Property: - a�/ate /'dcs G�c. G�,xr.nt+s ✓ ,04f ej_ 44 A.;� ,X0 /ry y
(Lot or Street #: Street or Road. City & County)
Agent's Name #: p�`� 91AI A MailingAddress:
Agent's phone #: 251- 30'i- Q10l
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.
o s 1 have no objections to this proposal. I have objections to this proposal.
/f you have objections to what is being proposed, you must notifythe 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 byCert/fied Mail
WAIVER SECTION
I understand that a 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. (If you wysh to waive the setback, you must initial the appropriate blank below.) RECEIVED
Z
o_��do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si�rnnur//e 3
Print or Type Name
,iU/ Xso /r.,17
Mailing Address
Citylstatelzip
Zs'z—
Telephone Number/Email Address
Pate
`Valid for one calendar year after signature`
MAR 3 D TU23
(Adjacent Property Owner Information)
Si,Kr`irrrtri•e� �
Print or Type Name
400
Mailing Addreso
C taw& (r � OM Y)C
City/State/zip TT
a�-d �ss- ,715 _f0"t5
Telephone Number/Email Address
3 - )©
Dale*
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: /✓jiza��C4, ,f
Address of Property: 2-t7 /�F s�! csramp.✓ ANC
(Lot or Street #, Street or Road, City & County)
Agent's Name #: �P i` f r Mailing Address:
Agent's phone #: C oi- 261' i.101 ��t/�� a�716
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.
zl`� l have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the 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
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.) RECEIVED I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement. t.1AR 3 0 88
(Property Owner Information) (Adjacent Property Owner Inform 6tiC
SiKrxr rLLrr//v / .Sisrnnnn•e'
Print or Type Name Print or Tyl e Name
� r ire r✓,L
Mailing Address
6., +., ele d
City/state/Zip
Telephone Number/Email Address
Q2s
Ane
*Valid for one calendar year after signature*
10:�2 &2? Acc-� yl--�
Mailing Address
C+M06� Nc 2�gz1
City/State/Zip
Telephon Ni ber1EmailAddress
37RZ3
Daw*
Revised Jan. 2017

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