89877A - Gulley

H CAMA ❑ DREDGE & FILL N9 89877 ° F, B C D
GENERAL PERMIT Previous permit
Date previous permit issued
0-F,]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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.den.nc.gov/CAMArules
Applicant Name _
Address
City r'
Phone # ( )
Email
.;I
State )•) <.. ZIP "1
Authorized Agent ! i /
Project Location (County): ^ "! 1 t Y ! 4 V <'
Street Address/State Road/Lot #(s)
j
Subdivision , "I
City ( ZIP
Affected ❑CW ❑EW E"PTA nES nPTS 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: )
Shoreline Length
Access Length
-y
+-
�r=
"✓
Pier (dock) length
1
I
)
{
Fixed Platform(s)
-
,
�
r
.
I
'.
I
I
Floating Platform(s)
�-
j
Finger piers)
r
Total Platform area
Ga,
-
_
r,
_
Groin length/# i
r
Bulkhead/RipraP length
Avg distance offshore
-
Breakwater/Sill
—jtf
L
Max distance/ length
x
Basin, channel
Cubic
�-
's.-''
yards -
_
(n
c'
,"
(
<-
—
Boat ramp
Boathouse/ Boatiift
'..
j
..
•.,
t
_.
,..
.St
-
%;
t
y '+
Beach Bulldozing ; {W t
Other
j-1—
SAVobserved: yes no ; i i_
Moratorium: n/a yes no
-
-7"
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 odback of permit** Signature
Application Fee(s) Check H/Money Order Issuing Date Expiration Date

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DIVISION OF f,
ADJACENT
"e. :AM
-.�)-
(Top portion to be completed by owner or their agent)
Name of Property Owner
Address of Property;
Mailing Address of Owner:
Owner's email: Lh •,1feYtw rW arcs r 1--^.—Ws Phone#. 7S7°-1 J - O 79 a.
r.Ctr\
Agent's Name!
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(bottom portion to he mmnloted tm the Ae d a "wrteei
1 trerebyeertify that town Property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown 00 the aft oed drawing, fhe development Way are proposing•,6
d^No0go WULULigthLr
i'DO NOT have objections to this Prdprtsal. 100 have uft-
leotions to this proposal.
,w ••®-a . a�cduww W wnat rs wmg pfoposw
AftriagenriYou must nobly the N.O Ddaitt9dR 9d GOastai
ant (OfJ in urrNiteg wtthin 90 days of receipt of thia !retire. ee should be
mailed to 401 S. GTHfin St, St& 300, EdrabWh Cltl& NC, 27905'. MW repres®nbtivas ran also be
conlaetedat (252) 264-Ml. No response is considered the satin: as no if you have bon
noh0fed by CerVftd mail.
WAIVER SECTION M422ae onW grmrej
i understand that ally Proposed Pier, dock, mooting pkkW, boat ramp, breakwater, boathouse, K or
groin must be set beck a minimum distance of 1S from my area of riparian access unless waived by me
ttliis does not cooly to f+ kheads or dD an tt (if you wish to waive the selbec� you
the appropriate blank below.) \I �- .
1 DO Wish to waive somataa of the 16' setback
-flR-
I DD NOT wish to waive the IT setback Muiralnent (initial the blank)
Signature of Adjacent Riparian Prop" Owner:
Mailing Address ofARPO!AARP��
a5_ a_ r
[We: r is valid for up tO one year from ARPO`* Signature*
Revised August 2022

N.C. DPASION Of COASTAL MANAGEMENT
ADJACENT P%ApL*,4.W-,iq-2r
+ ..♦`._
op portion to be completed . owneror •:
Name of Property Owner
Address Of Property.
Mailing Address of Owner:
Ownee's smack c_k- � ;m- n s9ra (��-^�veets Phone#: a i - b52- o'Zct oa
�a1n
Agent's Memo:
Agent's Email;
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
[Bottom coition 4o ha oomo➢etad tnr the Adian.R cf.,. t o m- rl
1 twubyceartify that I own Property adjacent to the above referenced pr%
permit has described eNy. The individual applying for this
described 4o me, as shown On the attached u�'awing, the devstapment they are proposing. 6
descdO4iOn er draev D wilts dbnen '�na m�St be arc><1,i with tlsis beer
!L I DO NOT have objections to this proposal. _ 100 Have objections to sums proposal.
Iffixagarnent low in - ...® ...... —. .w. w my 111
emattad ro 461 S. Gr1lAn tS'#/recaipf o/this /ropes, shoo/dbe
Weed
of S. f. No C . NC, 27M DCtd reprosantaMw can stew be
eantacreef by Car54 2 Bfalf, rnssponss fa Considered the same as no ifyou have been
WAIVER SECTION (Choose o& anal
I understand that any proposed pier, clack, moofhV plktgs, boat ramp, breakwater, boathouse, jr, or
groin must be set beak a minimum distance of tS from my area of riparian access unless waived by me
d is_iioes not anrly to bulkheads a rirsrmn revehnentcl (if you wish to waive the set", you mum
the appropriate blank below.)
1 DO wish to waive Some/all of the t6' setback /C dx/
aR Sig Wore of Adjacent hVanan Property Owner
I DO NOT wish to waive the 15' setback re(Itlremerd (initial the blank)
11Ignature of Adjmnt Riparian Property owner:
TypedlPrhded name of ARPO! it'0D
4/-.f _�Lc2E
I
Mailing Address of ARPO: l/ r�/ls /S//yl✓!!; � f � ,1, e
ARPo'ssma11zer'° G'"^ti/ ` AARPO'nPhone#:7Si- 3 7S- -ol9 5S
oat*:.2 `o' ag *waiver Is valid for up to one year from ARPO'o 919nature
Revised August 2022