87008A - NCWRC

tipfp4°& Is ® DREDGE & FILL
GENERAL PERMIT
NY 87008 (3 B C D
Previous permit
Daze previous permit issued
®New []Modification El Complete Reissue ❑ Partial Reissue
As authorized by the State of North C"Ina, Department of Environmental Quality and the Coastal Resources Ctanmiston in an area of errvironnnenal concern pursue to:
I SA NCAC 114 - 1 I OQ ❑ Rules attached. ® General Permit Rules wilable a the following rink: my deonegov/CAfMnJet
Applicant
city Sate NC ZiP_aZ b0
Phone#(25a) -six -65Sf
Emall_ 1.;klljtl",g pC Ick�c11:.tlYq
Affeasd DCW ®EW ®PTA ®ES ©PTS
AEC(s): ❑oEA ❑IHA ❑I1W ❑SPIMA ❑PWS
ORW: yes/no > PNA: yes/e
rype of Project/ Activity
Shoreline Length r& aW
Access Length
Piet (dock) length
Floating Platform(s)
Finger pler(s)
Total Platform area
Grain length/#
BulkheadiRip lengthlength 1co,
Avg distance offshore
Breakwater/Sit
Max distance/length
Basin, channel
Cubic yards
Boatramp
Boathouse/ eoatlift
Beach Bulldozing
Other
SAY observed: yes 0 t"""""'
i
--{__•..
Moratorium: /yeSs� no
Site Photos: sygv no i 1J'I
Rlparian WaiwrAtarhed: yes (a
A building pe triVmOng permit may be required by:
Permit Conditions _
ywehorbed Agent
Project Location (Cou*)t 9A-3
Street/ddress/State Roadp.oc #(e)
I O'7 6 Sand hanks
Subdivision
Cityya ZIP ail 7
Adj. Wtn Body
Closett Mal. WQ.
(Scale:
❑ TARIPAlEUSE/BUFFER (ckde one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
IAMAWARE FSTATUTES,CRTJ) SAND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
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Issuing Date Expiration Date

&a CO 741&NCAMA ® DREDGE & FILL Nn 87008 B C D
GENERAL PERMIT Previous permit
a 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 114' ((00 ❑ Rules attached. ® General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name I
eU)?,T� C(6VCa a OPW.
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Authorized Agent
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Project Location (County): nQ'7C.5
City KQ 1 e IQh
State 1 V L'.
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ZIP 7 (O .(.
Street Address/State Road/Lot #(s)
Phone # ( @--)
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Email WJ��n
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Subdivision
City %ales ZIP 2%797
Affected ❑ CW
© EW ® PTA
® ES © pTS
Adj. Wtr. Body
na man/unk)
AEC(s): ❑OEA
❑IHA ❑UW
❑SPIMA ❑PWS
Closest Maj. Wtr. Body li1b9riLQ.r(2. souk
ORW: yes/ ro`
PNA: yes/0
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) -^
Finger pier(s) _
Total Platform area
Groin length/p
Bulkhea Ri 3 length �QOr
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes (a �J�
Moratorium: yeses noSite Photos: Syey no E— io jVC
Riparian Waiver Attached: yes ® p7e /+ 1
A building permit/zoning permit may be required by: �= S CO LA Av'1-s.
Permit Conditions
Agent or Applicant PRINTED Name
C'h0yaa n
ON3fLePT-O?
(Scale:
iD9
kilter,
P"P.
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
1-1 See additional notes/conditions on back
APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Permit
Signature **Please read compliance statement on back of permit** L (�
i q� cc, nL!Aey ItYLJ4StCr
Application Feels) Check N/Money Order
Signature r'
Iz19/23
Issuing Date Expiration Date

oa°§Co"r'V 29CAMA ❑< DREDGE & FILL N9 8'7008 ,A B C D
Previous permit
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 ❑ Rules attached. General Permit Rules available at the following link: www.dec.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)_
Subdivision
.J
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wt, Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: )
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Platform area
Bulkhead/ Riprap length
distance offshore
Breakwater/Sill
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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 on back of permit" Signature
Application Feels) Check #/Money Order Issuing Date
L'/y 1.,
Expiration Date

RECEIVED
N.C. DIVISION OF COASTAL MANAGEMENT OCT 3 0 2023
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY DCM t-'� f� A EC
(Top portion to be completed by owner or their agent) E
Name of Property Owner:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adiac nt 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 drawma. with dlmnnQinnc mncr do _. , I _.._
I DO NOT have objections to this proposal. 100 have objections to this proposal.
If you have objectlans 'writing
Js be/rig 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 some as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose only one
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 aooly to bulkheads or riprao rsvements). the appropriate blank below.) n {If you wish to wave the setback, you mus si
I DO wish to waive some/all of the 15' setback
-OR-
Signature ofAdjacent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank) "_
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
ARPO's email:
ARPO's Phone#: _ 2,U ^ ) ? —1M/o
Date: / ( 47 " 'waiver is valid for up to one year from ARPO's Signature
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY E�
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
NC Wildlife Resources Commission
1070 Sandbanks Rd., Gates, NC 27937
Mailing Address of Owner: 1720 Mail Service Center Raleigh NC 27699
Owner's email: ncwildlife.org Owner's Phone#: [phone]
Agent's Name: William Ridgeway Agent Phone#: I�S�) 319-4f 5R
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
RECEIV
OCl' 3 u 2023
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.
X 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 (Choose only one)
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 rigrao revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: )'Aa ol&�
]C159D2,94IF47E.
Typed/Printed name of ARPO: Paul Williams NCDOT Dtvtston Environmental Officer
Mailing Address of ARPO: 113 Airport Dr., Edenton NC 27932
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 10/30/2023 *waiver is valid for up to one year from ARPO's Signature'
M-EC
Revised August 2022

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