87097A - Williams, Charles

r�`°u'wvk�CAMA 12hLaREDGE &FILL Nn 8 O" `' B C D
Previous permit
{ GENERAL PERMIT Date previous permit issued
Alew ❑Modification ❑CompleteReissue ❑ 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:
f7 / Q a n e v/G�MArules
15A NCAC / f7 r 1 i ❑Rules attached. �Geneal Permit Rules available at the following link: ----
Authorized Agent I R t Y` e � G c o"n
Applicant Name earl �'S (�)�MS - 4
a ,D g $ Project Location (County):
Address
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City tt_� A State hj e-- Zip 17 Y 1S Street Address/State Road/Lot #(s)
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Phone #) .3 OS - 2 •I � n—_---_.
rA. S' D. n.a r l• L° n` Subdivision Y o t- A J
Email y y I S
ZIP
Ciry v n —
Affected CW a
ylr � [EPTA ES MPfS Adj. Win Body
C P./l � tnaq nev w
❑
AEC(,): ❑OEA ❑INA ❑UW ❑SPIMA ❑PWS Closest Ma). Wtr. Body
ORW: ye no PNA: ye no
Type of Project/ Activity n 4 (Scale. fJ T )
jV r
Shoreline Length e,
Access Length ^_ 1 Lek n
Pier (dock) length 7
Fixed Platform(s)
r --
-
Floating Platform(s)
J I
I Y /- /
Finger piers) _ I ---j l - i= F I "I �1c i S T r n� Q' I r A S
Total Platform area
_ yllf/'
Groin length/H
Bulkhead/Riprap length
I
Avg distance offshore r
Breakwater/Sill—
Max distan length-
Basln, channel
Cubic yards
Boat ramp Y- C
Boathouse/ BoatliR T k G't\26de
I t
Beach Bulldozing - I � -,
Other I - b . � h
SAV observed: yes no
Moratorium: n/a es no _ L
Site Photos: ..Yes no
Riparian Waiver Attached: no
A building perm!Vzoning permit maybe required by: <D
TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
See note on back regarding River Basin rul
See additional notes/conditions on back
:r's PRINTED Name
(Please
Signature,PPease read cornpliancp statement onrdrot permit•' �1 I
JO
Application Fee(s) Check II/Money Order
Issuing Date
2- I ?-
9- I '
,n Date

o�CAA DREDGE & FILL N9 87097 A s c D
FM[IPrevious permit
GEN ERJAL 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 }-' 1 i �' ❑ Rules attached. '❑ _ General Permit Rules available at the following link: vvww.deq.nc.gov/CAMArules
Applicant Name C K O0. r J rd; q (✓s )' i f
Addressz-'
City State ' ZIP
Phone#O
Email :.ti, „ • o ro..
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body (nat/man/gnk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mai. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: N )
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A building permit/zoning permit maybe required by: "1) � ( C.
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 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 onback of permit`* j Signature
Application Feels) Check q/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Hgtll I1 /
Z7Sr5
to act on my behalf, for the purpose of applying for and obtaining all CA A permits
necessary for the following proposed development: o
at mypropertylocated at
U,J in ryJ *'e County.
1 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:
—0) 21"s
Signature
NA-f2lOS
rint or Type Name
Date
This certification is valid through Ll l115� l zvzc/

rDc. R 6 l
is

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: ( //X,& , �/✓`
Address of Property: `-r Uy
Mailing Address of Owner:
Owner's email lN�oll
✓ -cf ,
9e,-K [ Z
4�wu Z26
Owner's Phone#:
i
Agent's Name:
Agent
Agent's Email:
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. 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 somelall of the 15' setback
Sign Pure of Adjacent Riparian Pr rty Owner
no
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 ARPO:
ARPO's email: ARPO's Phone#:
Date: 2- ? Z- *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
Name of Property Owner:
Address of Property:
to be completed by owner or their agent)
Mailing Address of Owner: /r — G
JA /2Zc
Owner's email: y-)� . t' 1 k,-J, c^-Owner's Phone#:
Agent's Name:
Agent's Email:
Agent Phone#:
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. 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 Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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