87009A - Stumpel, Willian and Wendy

SE]New
OCAMA ❑ DREDGE & FILL N9 57009 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
[:]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 I I 1 ❑ Rules attached. ❑ General Permit Rules available at the following link: ww vdeq.nc.gov/CAMArules
Applicant Name
City
Phone # (_ )
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no. PNA: yes/no
Type of Project/ Activity
(Scale:
Access
Pier (dock) length
Fixed Platform(s)
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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
Signature **Please read compliance statement on back of permit"
Application Feels) Check Jt/Money Order
Permit Officer's PRINTED Name
Signature
1
Issuing Date Expiration Date

Name of Property Owner Applying for Permit: W + �+ rr S-r ull re
Mailing address: 36-6
Ua.v, 4-a-m In l/V 117 R 3
Telephone Number:
1 certify that I have authorized 10 AJ+S +1 ~J Dedelopeo,^.+ (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of &�I h kiec/
at my property located at 1 t $' for k 5rertor� iVC 7 q Y
This certification is valid through
(Property Owner Information)
/) Sign[a+tur
+�11 r A..M J telk4? G l
Print or Type Nam
Title, co, owner or trustee for property
!/ /6 123
Date
5'"16-6Su'-9035"
Telephone Number
EmailAddress
(date).
RECEIVE
Nov 01 2023
DC1 —EC

(Top portion to be completed by owner or their agent)
Name of Property Owner, 1,o yt J f f
Address of Property, L S" t a, % 9r. Hee-ti
? A � /�a7R�'�
Mailing Address of Owner: 3SbS� % j-j- Lr L✓gnTt hi NY /r7 RECEIVED
Owner's email: �� I. UeOwne s Phone#: 5/6 -' a g d j ti
NOV 0 7 2023
Agent's Name: rown,s l y Avid Agent Phona#: u�2 4� x 6 ^ G $`—
Agent's Emait DCM—EC
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
ffl� 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 nprap 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 � 4^
Signature of Adjacent R071an Proper# Owner
_Op{_
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: N!,#^ 1 I� r n ftr LCA
Matting Address of ARPO: 1 SIG i`iPm to a� �r
ARPO's email:/ _ ARPO's Phone#:
Date: �� -*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

N.G. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER 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:
Mailing Address of Owner: S'6 5- %a.t r 57- Wco,"A 1,1y 117
Owner's email: Ga; f{ f ppC1( A.Awner's Phone#: '3r16 --✓i Ste$ 4d Ji r C
Agent's Name: �ewn'r v 10 04 Agent Phone#:
Agent's Email:
1 2023
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Bottom portion to be completed by the Adjacent Propetty Owner) DM
p A CG
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. I DO have objections to this proposal
I f you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (L)CM) 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.)
100 wish to waive some/all of the 15' setback tZ,
Signatu Adjacent Riparian Propgrty-G* r
•OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO: &' U
Mailing Address of ARPO: 1 q �% y em t. aG i< J T LrR7(`oRf? %f
ARPO's email: ARPO's Phone#:
Date: _*waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

_ECEIVEM✓
Nov 15 2123
DCM—EC

N.C. DIVISION OF COASTAL MANAGEMENT p e�' I VE D
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FC1RU:
CERTIFIED MAIL- RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) NOV 2 7 2023
Name of Property Owner
Address of Property:
yvII1;am Sturn-ee..) ii M-EC
-116 eD Y K St Htrtkyd NO Z7n44
Mailing Address of Owner:
(13
Owner's email: YJ 1tW 16 Dpf�Awner's Phone#: 6 lu— L, Sg ^ quas
Agent's Name:�BDWM Lar)d DCVQOPi'Y%c) Agent Phone#: ?=l 0aj0s-�;-
Agent's Email: S�t4. bU i(Y d Cato/►— wy,
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Progerty 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. I DO have objections to this proposal.
N 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/ail of the 15' setback
Signature of bydjar any 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: .) o k�'A, t rR�
Mailing Address ofARPO: f'd, Lt
ARPO's email:
ARPO's Phone#: [phone] �rcl r?
Date: _ // / J� Z3 "waiver Is valid for up to one year from ARPO's Signature'
Revised July 2021

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