87119A - Kessler, Ben

❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
FvltNew [-]Modification ❑ Complete Reissue ❑ Partial Reissue
N987119 A 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 /✓ _I It .16 (;> t,.� �
s,Ji ((! 2. o 0
❑ Rules attached.
❑" General Permit Rules available at the following link: www.deq.nc.gov/CAMAmIes
Applicant Name %a f-a In i'=
f'_ ' >!5 ( R' r"
Authorized Agent
Address
Project Location (County): {'r i rr• r t i i r -
City IC.t i'+,J H' t w: k; State hl !:'.
ZIP L'P Y :i
Street Address/State Road/Lot #(s) Tr- •o in. } 79 1 r la 1 cfl) F' f I l o
Phone#
ts
t-Ii I. I.i t30 b0.(>c3"-54/A
Email
Subdivision
`
City r"ns r ct" k_ ZIP2.1CY2
Affected ❑eW DEW
EPTA
DES QPTS
Adj. Wtr. Body C.o rt, t0r'. 11 Ind{ iTayman/unk)
AEC(s): ❑ OEA ❑ IHA
❑ UW
❑ SPIMA ❑ PINS
Closest Maj. Wtr. Body C ' r r
ORW: yes/no PNA: yes/no
Type of Project/ Activity
o L hncAaC) Y-
i' (Scale:I" ti )
: 5
Shoreline Length
Access Length .�
__
Pier (dock) length
-
-
1--
----
.L
Fixed Platforms)' r
Floating Platform(s)
• r
Finger pier(s)-_
ow
_-
Total Platform area
Groin length/#
Bulkhead �._Riprap length. i 6 %
..
Avg distance offshore
—�
r
-
r.
r�
-
Breakwater/Sill —
' .'
t
-
_
r--
?gL;
7
_
Max distance/deng[h
j'_
Basin, channel ''
Culbicyards-
Boat ramp..-
Boathouse/ Boatlift
Beach Bulldozing
Other
r
I
kA-
SAV observed: y es no
Moratorium: n/a es no
Y
Site Photos: .yes no
r---
-t-
__-._--
-
--
Rivarian Waiver Attached: Yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ TARtPAM/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 Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: hen Y-2JS`ei(
Mailing Address: 3W wntac�a✓cli ACA
i�4a 11yw�L g-19
Phone Number: Ld8- -141 - 6653
Email Address:
I certify that I have authorized T)Ll10 .4nAab✓ QWi2.
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ,D Lliq t P J . a✓lcl
UMsm
at my property located at SC act W 1 Wok-Fr,r 1t I4 ALA
in PutirJor IL County. PAYCC 1 Zn = E3cx�t�cp$yA000a
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.
Print or Type Name
7V /
Date
This certification is valid through

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: Y>f n
Address of Property:
Mailing Address of Own,
Owner's email:
Agent's Name:pa Arki&rtiit, &&L
Agent's Email:
Owner's Phone#: [phone]
Agent Phone#: qeo) " (0.5 a
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
to this proposal. I DO have objections to this proposal.
7f ydu have bjections to what Is being proposed, you must notify the N.C. Division of Coastal
Managrem t (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 /s 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 15from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wishto ive the setback, you must slnn
the appropriate blank below.) -1---
I DO wish to waive some/all of the 15' s
-OR-
Property Owner
I do not wish to waive the 15' setback requirement (initi5l the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: JC DUI An , ✓
Mailing Address of ARPO: Cow)ocic
ARPO's email: 2 ARPO's Phone#:
Date: 11' I I' 3 "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 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:
Address of Property: If
Mailing Address of Owner: ')L'x. Qx1. V--14) IiOtwi. W-r 9-1 M
Owner's email:
Owner's Phone#: LI`t R--1Li 1- 5 55_3
Agent's Name: loci n j nAyr rwiw i }2. Agent Phone#:
Agent's Email: 5hMLxy%y1A--1 9 QVYLAI C<ty1
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.
)ip
. ' 1 / 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 or voastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
malted 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 revetmonts). (If you wish to waive the setback, you must slun
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 Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARP/O:: q'I\ Clvr-(At Batt \IA r
ARPO's email fz'�.v,90c,a �/,kZ ''a ARPO's Phone#: 7S
Date: LQ ^ { I'o`Z 3 `*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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