87069A - Gardner

C'bREDGE & FILL
F GENERAL PERMIT
[+New ❑Modification [:]Complete Reissue []Partial Reissue
NCB 8I0E9 0 B C D
Previous permit
Date previous permit issued
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 U 1IA • 6 i 00 ❑ Rules attached. General Permit Rules available at the following link wwwdeygBov/CAMArules
Applicant Name ) n. fi C, P i ri lll< Authorized Agent �ltu L.Gi r'
r
Address It' sS 5' Gow 5 ,� c7 t.J 2 n {� � Project Location (County): t' %
City State —JA ZIP 2� Street Address/State Road/Lot#(s) I�j (,� ��{r'Rt mf—
Phone#(_)�E-
Email_r:Ck pV4,gVjAtip Q"i'-�r� nt�nrx.t I • G ZSM - Subdivision cd Yl Lo+ k 5ICLVtr,
City ` r4 h ZIP
CW
Affected QE�c{na nk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body Orr t •ir Ur-l[_ C�2nJ hA
ORW: yes4V PNA: yesb
Type of Project/ Activity
Shoreline Length 10,01
Access Length
Pier (dock) length
Fixed Platform(s)
Floating
Finger pier(s)
Total Platform area
Groin length/g
Ripraplength '7,.Y I00 ead
Avg distance offshore .�.. s
Breakwater/Sill
Max distance/4eog1M
hr
Basin, chant
Cubic yards
Boat ramp _
Boathouse/
Beach Build
Other_____
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Anached:
Yes
yes no
ye no
yes no
A building permit/toning permit may be required by:
Permit
Agent or Applicant PRI NTE DWSme
William Eger
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Signature --Please read compliance statement on back of permit"
$ �I. n t� • ''Q S" l '� 1
Application Feels) Check H/Money Order
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Older, h t t uL
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❑ TARIPAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
VD REVIEWED COMPLIANCE STATEMENT. (Please Initial) We
M!ir6 " K
Permit Officer's PRINTED Name
�71
Signature
1.40 +1G(2= —
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Jason & Cindy Gardner
Mailing Address: 2551 R �n "ray,, ran.. W� Rnaf1
71 ini ern 238gII
Phone Number:
Email Address: [e-mail]
I certify that I have authorized Affordable Bill'sfWilliam Eger
Agent l Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Install 100' +/- bulkhead and
fill where needed.
at my property located at 156 Edgewater Dr. Grandy
in Currituck County.
f furthermore certify that I am authorized
Division of Coastal Management staff, the
on the aforementioned lands in connectit
permit application.
Property Owner I formation:
Signature
Jason or Cindy Gardner
Print or Type Name
Owner
Title
, I , Zo23
Date
This certification is valid through
to grant, and do in fact grant permission to
Local Permit Officer and their agents to enter
in with evaluating information related to this

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Jason R Cindy Gardner
156 Edgewater Drive, Grandy
Address of Property:
Mailing Address of Owner: 25518 Bows Arrows Rd, Zuni, VAS 23898
Owner's email: r .I .mc P entc0399&gmaH com Owner's Phone#:
Agent's Name: Affordable Bill's/William Eger Agent Phone#: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that 1 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.
1 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 noury me iv.c. uiwsion or r uasrer
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
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: .lohn of Vivian Mattox
Mailing Address of ARPO: 1 F_- R Ffl�alniatar I�r Grandy NC
,T0tiij n4 fElc34 C 6!vnAlL . C40 1�
ARPO's email: ARPO's Phone#: �S 7 'Iy yet 7
Date: 23 023 —*waiver Is valid for up to one year from ARPO's Signature`
Revised May 2021
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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: Jason & Cindy Gardner
156 Edgewater Drive, Grandy
Address of Property:
Mailing Address of Owner: 25518 Bows Arrows Rd, Zuni, VAS 23898
Owner's email: cclements039g ail rom Owner's Phone#:
Agent's Name: Affordable Bill'slWilliam Eger Agent Phone#: [phone]
Agent's Email: [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
descri-tiog 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 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
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
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Properly Owner:
Typed/Printed name of ARPO: rol Kiitrhenritar nr Avis Jordan
Mailing Address of ARPO: _154 Edgewater Dr Grandy NC Lj
ARPO's email: ARPO's Phone#:
Date: g�/fir 0a3 'waiver Is valid for up to one year from ARPO's Signature*
Revised May 2021
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