87058A - Anne Thomas

aa`°�`"� C�CAMA [DREDGE &FILL N9 97058 0 s C D
GENERAL PERMIT Previous permit
Date previous permit issued
[✓New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized bythe State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concem pursuant to:
I SA NCAC l7 1 N , i IQ a ❑ Rules attached. eGeneral Permit Rules available at the foltovdng Ink. -
Applicant
Address ��i� D Srs�(NJ LLM
city���a.ht� Chi__ state zip 'LT-) 4 a
Phone #
Email
Authorized Agent_ L4 �r M0_Vif.Re
Project Location (County): '_'( meL
Street Address/State Road/Lot#(s) '-29 06 —Aaa_T
Subdivision _
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Affected ❑cw MEW F�PTA yEs [V(PPTS Adi.Wo.Body rin�l�}t, C.re.t,l;C ----------- n/unk)
AEC(s7 ❑CIEA ❑IRA ❑VW ❑SPIMA ❑PWS Cbsest Mal. Wtr. Body n,+u=auck GauyiA_._.
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Type of Project/ Activity :Eh9 k:
Shoreline length
(Scale: I"c3o )
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Aaoss Length
Pler(dock)length �•1 �st�N�7�tt C�.GtG� ^'' /�.�
Apler(s)
Platform(s) a
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ulkhea Riprap length
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Avg stance offshore�_l �`rc
Breakwater/sill 3
Max distanceLksek—
13z' rizoposso •••
1046IMR OuLkNEA-D
2r ••�WL �
cubit yards .. U rP Y-,i; r
Bp tramp jsiWL
Boathouse/Boatlih /2•Sr 3 2i d4
Beall Bulldozing
Other J O
SAV observed: yes no..�
Moratorium: n/ ye no /
Site Photos: yes
Riparian Waiver Attached: s nono
A building permit/zoning permit maybe required by: {� Vf{,off{��---
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Permit Conditions________ _
on back
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❑ TARIPAMINEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
© See additional notes/conditions on back
AND REVIEWED COMPLIANCE N STATE(M�ENL (Please Initial) 01.7
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Permit Officers PRINTED Name
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issuing Date Expiration Date

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As authorized by the RMI r
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Access teength Wtr. Body zip ,.,
ngth 5
Pier (dock) l
Fength
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Floan'ng Platform / / 4GU tj r
Finger Piers) 1i
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Total pl /Scd/e; I
Groin length m area
A g];,S Rip aP length r -✓ .✓ Stt�k`I CII� \,
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ngPermi[/zoning Permits
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°nditions mit may be
requlredby:
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mtPRI RUtESANDCDNDITIONS Q TAWpAII"NEUS de one)
PRINT
Name
THAT APPLY TO THIS See note on bac E"auFFER (circle er Basin rule,
e read o�mPliance state PRDiECTANO gfV/EWfO COMP Q See addthOnal not regarding Rivergaohe) is On back
.` statement back ofpermi['M Permit Officer' L/ANCE STATEMENT e$/conditions on back
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' s PRINTED ryame C (please lnft/al)
Check q/Money Order Stgnah, \ _
Issuing Date Z

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: AAly < f✓ �,nI .L_
Mailing Address:
xii�p�� crf�C Ak-
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: A /g-0 I'�,)(tiC. -#tJ-
at my property located at
inCounty.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
t�iGrJr'l eY
Title
2 02-3
Date
This certification is valid through 1/e-2l 31 l 2 023

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: ANNE V. THOMAS
Address of Property: 99 OSPREY LANE, SOUTHERN SHORES, NC 27949
Mailing Address of Owner: 99 OSPREY LANE, SOUTHERN SHORES, NC 27949
Owner's email: NIA
Agent's Name: SCOTT C SMALL
Owner's Phone#: [phone]
Agent Phone#. [phone] ofc / 252.473-7695 Scott cell
Agent's Email: [e-mail] / [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be Completed the d 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
descriP ion of drawing with dimensions must be Provided with this letter.
V_ I DO NOT have objections to this proposal. I DO have objections to this proposal.
rr you nave 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 some 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 si n
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signaturo of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Own
Typed/Printed name of ARPO: DOUGLAS & .yOAN BRINDLEY
Mailing Address of ARPO: 103 OSPREY LANE, KITTY HAWK, NC 27949
ARPO's email:
Date: 10/25/2023
ARPO's Phone#:
252-305-6175
*waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

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: ANNE V. THOMAS
Address of Property:
99 OSPREY LANE, SOUTHERN SHORES, NC 27949
Mailing Address of Owner: 99 OSPREY LANE, SOUTHERN SHORES, NC 27949
Owner's email: NIA
Agent's Name: SCOTT C SMALL
Owner's Phone#: [phone]
Agent Phone#: [phone] ofc 1252-473-7695 Scott cell
Agent's Email: [e-mail] / [e-mail]
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
I DO NOT have objections to this proposal. _ ._ 100 have objections to this proposal,
a you nave ooiecnons 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 some 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
-OR-
Signature of Adjacent 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: MARK & CHRISTINE MUELLER
Mailing Address of ARPO; 2401 MOUNT B �L-A'NCO ROAD,
C�HESTE[/R1,(,VA 23836
ARPO'S small: 1 1 ��A N-• � ) I' ��f/ "A'RP Ss'�F�one#:, V V 1 _ � �� � �'� ��
L
Date; Z '3 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

GINGUITE 7
MARINE
Construction, LLC
CREEK
P/L
I 11030SPREYLANE-
P�
PROPOSED NEW PERTY.017:1 IPRO
TIMBER P I
BULKHEAD &
G BRINDLEY
EXISTING
BACKFILL -
APPROX. 130 LF
W/3'+/- HIGH PIER &
EXPOSURE
BULKHEAD
EX, PIER & BULKHEAD
P/L
130'+/- 101i6SPREY
99 OSPREY
P/L LN P& THOMAS
PROPERTY� OF:;_.',
I ' I _ I
r.
_P/L. 97 OSPREY LN
THO',MAS.
1_4
lzx i r
-4
`(PROPOSED NEW TIMBER
FOR ANNE V. THOMAS
OSPREY LANE
II
@ 99 OSPREY LANE, ES
ffillmillill
,NC
IRIPARIAN DRAWING 1 OF I - 10-24-23 - NTS - BY: SCOTT C SMALL OF LSI MARINE
252-473-7695 [e-mail] - WWW.LSIMARINE.COM