87031A - Martin

aoa#tour4" ❑CAMA ❑ DREDGE & FILL
3 GENERAL PERMIT
N? 87031 (a) B C D
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 i ❑Rules attached. ❑ General Permit Rules available at the following link: wwwdea.nc.gov/CAMArules
Applicant Name %',' <' `•- ` !>~ /1 << fY1 '� I"- 4+ it
Address
City State ZIP
Phone # ( )
Email
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Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body ( (naUfian/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: A/ i- )
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Total Platform area
Groin length/#
Bulkhead/ Riprap length
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SAV observed: yes no
Morato■�■
Site Ph yes no
Nriarla"Vaiver*ttm
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notos:
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IN
A building permit/zoning permit may be required by: D " C "
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❑ 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 statemenfon back of permit*" Signature
Application Feels) Check q/Money Order Issuing Date Expiration Date

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Emali Address: S ame rareavra} Iij��n rite f cA
I rerdty that I have authorized ti7 Y4nJ4 Opa ge
7 ConY•ctor
to act on my behalf, fox the purpose of applying for and obtaW g all CAMA permits
necessary, for the following proposed development:-Z,.".ku ajg k
at my property bested at go/7/ C4 C rU p l4von IVC a 7Q1,
In J)aee County.
t furthermore certify that l am aut *dmd to gram, and do in fact grant permission to
Division of Coastal Management stall, the Local Pemrlt Oft" and their agents to enter
on the atoremantioned lands in owwOon m1h evaluating kibrmatlon related to this
pe+mk applkadon.
Property Owner infonssdon:
This cerdfbagon Is valid through I l

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. • ' --- -- -- ,,:o.=�'y uvimar or ineir agent)
Name of Property owner: jori�p h r1 r P //
G7'YY/ ir�
Address of Property: 10 17 t Cf, e-, va, Gd i
Mailing Address of Owner: 1$DI✓�ev,,v,r, t v t r
Owner's email: f4 Owner's Phone#: '7f 7-Rl7Et • a[ i
Agent's Name:
Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion Qo be comolatarl r . aw_ n cant RMR
I hereby certify that I own property adjacent to the above referenced property, The Individual applying forth Is
permit has descrlbed to me, as shown on the attached drawing, the development the are ro Proposing. A
description or drewino with dimensions . Y p po
be orovidad With this letter.
I DO NOT have objections to this proposal. ,_ I DO have objections to this proposal.
If you havamee objections to what la being proposed, you must notify the N.C. Dlv slon of Coastal
Management have (OCMJ In writing within 7D days of recelpf of this notice. Correspondence should be
crated a got S. Griffin264St, Ste. 300, Elizabeth C/ty, NC, 2700a. DCM representatives can also be
contacted at (282J 264.380f. No response Is considered Phe same as no obJection If you have been
notified by Certified Mall.
I understand that an WAIVER SECTION (Chgoos�oyel
groin must be set back a minimum distance of 1ier, dock, 5' from my area tof riparian access mess Waiveddby me
(this does not applyr bulkheads or riots. rev tments)• (if you wish to waive the setback, you ust si n
the appropriate blank below.)
I DO wish to waive some/ell of the 15' setback
-OR- Signature . mulacenl Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank) _ _ Q0W
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Sio %-rI M .. ,. l., ..
Meiling Address of ARPO:
ARPO's amail: I M 0.0I-e i'
0 A-t-.0 f. � (14
Phone#: _70 3 , 40g_ Sr) 17--�
2, 3 *waiver Is valid for up to one year from ARPO's Slgnature"
Revised August 2022

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)
9
Name of Properly Owner. y�il�yle 4- I G nA n'1 n &/ _
Address of Property; NO 171 Cy. t k=,� R.j Atr II'(
Mailing Address of Owner. _ Q ✓ -- - I (1)� "4,4z yiy 1 y 5"if d
Owner's email: 4A Pad Ale¢ Owners Phone#:11 7 • 47 •• - y6
Agent's Name: Agent Phone#:__
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bosom portion to be completed by the Adjacent ProaM Oyne )
I hembycertlfy that I own property adjacent to the above referenced property. The Indivklual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. 9
deacrlotion or drawlno with dimensions must be provided with this letter.
_V 100 NOT have Objections to this proposal. _ 1 DO have objautiom to this proposal.
Mae N.C. Division of Coastal
nagement (DCM) In writing withintl10 PoOposear, YOU Must notifydays ofreceipt of this notice.�Correspondence should be
matted to 401 S. Griffin St., Ste. 300, Elizabeth CRY,, 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 onel
I understand that any proposed pier, dock, mooring pllings, boat ramp, breakwater, boathouse, lift, or
groin must beset back a minimum distance of 16' from my area of riparian access unless waived by me
(ihla dose not ao IY to bulkhead I r ). (if you wish to waive the setback, you must elan
the appropriate MOM below.)
100 wish to waive some/all of the 15'setback
-OR-
Slgnefor. ofAdjecent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank) n �T
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Natalie Trunow
Mailing Address ofARpo:40173 CC Gray Road Avon NC 27915
ARPO'saman;[e-mail] ARPO's Phone#:______
Data: _ 10/4/2023 _*waiver is valid for up to one year from ARPO'e Signature -
Revised August 2022

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