89959A - Adams, Damien

_A0 VOMrk ❑LAMA ❑ DREDGE & FILL N9 89959- A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of Notth 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.deq.nc gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # (-)
Email .@ rP'kS'R'M3ff�kt.
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW DEW D'PTA ❑ ES ❑ PTS Adj. Wtr. Body , ii (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
u
(Scale:C)
Shoreline Leneth
Access Length
_
FPier ixed (dock) length
Floating Platform(s)
Finger piers)
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Total Platform area (f-1./-! "¢(: '"
Groin length/11 '
Bulkhead/ Riprap lengthr
Avg distance offshore
Breakwater/Sill—
Mazdistance/length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlik f)
Beach Bulldozing ! [ _—__i.__-
Other
1-7'�
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: .yes no
Riparian Waiver Attached: Yes no
A building permit/zoning permit may be required by - ; t Y^ r r 11 C r^e I u v*%- �1
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
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Application Fee(s) Check q/Money Order Issuing Date
Date

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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: Da,-; eh ► c6t I.S
i
Address of Property: �� ✓�i�% jN t� CG:n�Ub� r h , G
Mailing Address of Owner: 5 MjrN E rU
Owner's email: rl Jq) Owner's Phone#: do3 '-sso - -/u e J 3
Agent's Name: l ftden jnc4ft l e r Tn C. / A�`g//ent Phone#: �Sa - 33 - G3 ✓
Agent's Email: �GrrnClEnll�Ct�ne Q l7y>Lyvttrr� Co/�
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.
if yo�ections 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' setback
Signature of Adjacent Riparian Property Owner
S* .a
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO:
Mailing Address of ARPO:A42 12,eaez a/
ARPO's email: 1, 42 aL tf23RPO's Phone#:(6 a r S /d a
Date: e• *waiver is valid for up to one year from ARPO's Signature*
p[pcuJC IJ2 esubr�u � I a jd &% vvtr tr• 1 n e Revised July 2021
IvJ P,O. 66x llW

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION V
5Tevel15flk,feo1-
Name of Adjacent R3'parian Property Owner
W& WAfeltlily Qeau�
Address`.
(^014k foe 7,1Y43
City, State Zip
To Whom It May Concern:
PERMIT)
7Z91d(3
Date
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit to '
on my property at
a
in CjAr',14tec,i — County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
(LOCAL PERMIT OFFICER, NAME OF LOCAL GOVERNMENT, MAILING ADDRESS CITY, STATE, ZIP CODE)
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact (LOCAL PERMIT OFFICER) at (PHONE: NUMBER), or by email at: (LPO EMAIL).
Sincerely.
®amiU) hoaw,S A63-5S9-q03
Property Owner's Name Telephone Number
Address City State lip
V I have no objection to the project described in this comxoondence.
I have objection(s) to the project described in this corresnonden�
diacent Riparian Signature
Slwtej S�W
Print or type Name
Lzy tz3
Date
7o3-qK /65'3
telephone Number
.Address City State
"Lip

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