87109A - Hooper, Douglas and Melissa

�° °"" ❑CAMA ❑ DREDGE & FILL No 87109 'n) B c .. D.
a� Previous permit
3 GENERAL 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:
15A NCAC / r ` ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.ncgov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State
Authorized Agent I
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
I
Affected ❑ ON ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mai. Wt, Body
ORW: yes/no PNA: yes/no.
Type of Project/ Activity
(Scale: )
Access Length
---
—---
Pier (dock) length '--I—
Fixed Platform(s)
I
,
I
\
Floating Platform(s)
Finger pier(s)—
Total Platform area
•
—_
—�.��
_
_.
(—
_
-
_
Groin length/#I--I.
Bulkhead/ Riprap length
Avg distance offshore
—
—
Breakwater/Sill
--
- I
Jj
j
r
Max distance/ length
Basin, channel
It
(
s
Cubic yards
I
'
1
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
•,n
-
<,p+-,C-..s`
SAV observed: yes no
Moratorium:y
: n/a yes no
SitePhotos
Riparian Waiver Attached: ves no
i
i
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I
A building permit/zoning permit may be required by: !? . � t V\rd
❑ 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
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
t
Signature**Please read compliance statement on backofpermit** Signature
722-
Application Feels) Check#/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: S
Mailing address: 1 �- i 1 V- f)k
Telephone Number: IL 2 ) .'
I certify that I have authorized tS0 Li t I)V�,4,' (agenticontractor).
to act on nay behalf, for the purpose of applying and obtaining all LAMA permits
necessary for the proposed development of 'e-IX e. f
at my property located at
j
This certification is valid through I( (date).
(Property Owner Information)
Signatureq RECEIVED
/�41t' L1 S.4 DEC 1 4 2023
Print or Type Name
rz - txwtt ..r- 0CM-EC
Title, co. owner or trustee for property
—rtDate
Telephone Number
I'Akb rn?4-42l7_;C?-'C carte
Elmall Address

N.C. DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or jiAND DELIVERY
(Top portion to be completed by owner or their agent)
RECEIVED
DEC 1 4 2023
nr;M-Er
Name of property Owner:
Address of Property:
Meiling Address of Owner.
Owner's email: 1}j tvf� y=( x is t'rV� Owner's Phone#: �'-c>'2 J��t�ff �3
Agent's Name: �[l1f6r�5.. �+Q(. l�yttopir% Agent Phone#:U,&_) (42-U leSS
Agont's Email: QbL u.. btk inc `L!' o1&±3QOK .COM
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Q2jleM p2jalop jQ jro completed by the Adlacont Property Owner)
I hereby oertlly that I own property adjacent to the above referenced property. The individual applying for this
pennh has described to me, as shown on the attached drawing, the development they are proposing. A
OQe,�rfpifon or drawinq,,wittt dimtlnsfpns must ba rovitled with this latter,
100 NOT have objections to this proposal. I DO have objections to this proposal.
if you have objoctions to what 1s be g proposed, you must naflfy the N.C. DIv/ston of Coasta'f
Management (DCM) to writing within 10 days of receipt of this notice. Correspondence should be
malted to 401 S. Griflfn U, Sta. 300, Elizabeth City, NC, 27909. DCM ropresontstives can also be
contacted of [phone], No response is considered the some as no objection Ifyou have bean
notified by Certified Mail.
WAIVER SECTION (Choose only ono)
I understand that any proposed plot, dock, meeting pilings, boat ramp, breakwater, boathouse, Ilft, or
groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me
(this does not sooty to bulkheads or rintap revetments). (It you wish to waive the setback. you st
the appropriate blank below.)
100 wish to waive sometall of the 15' setback
Signature or Adjacent Riparian Properly Owner
-OR-
DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: A,° , ')i A�-4k,�I j t 'r-
TypodrPrinted name of
Mailing Address of ARI
ARPO's small:
S`j(2 0
pate:! 13 L "� *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM rr-DEC 14 2023
eOTtrian man . ATI IPIJ RCr rIPT Pr nl IGCTFn or HANn nFLIVFRY
(Top portion to be completed by owner or their agent) ��yy� r�� pp
'A" t I A, I.; i I L,fCM-EC
Name of Property
Address of Property.
MOiling Address of Owner, AVli4,
p(Z
r
owner's email fi A"\ioY r1Q i, .-C"��')",�j 1 Owner's Phona)t: � � _ %(
55
Agent's Nnme�! S J Agent Phono(A( )t-iz-�.P 13i.PS�
Agent's Email! Qh1 I_buj • b�G(i
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
fiiattom nortton to bo eomaleted by he Ad(gr@ttIt Praaortv Owuor)
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 dovoloprnent they are proposing. A
ri li n rye} gn willr i lions muss 6e arovidstl with ibis letter.
1 DO NOT have objections to tills proposal. 100 have obJactlons to tills proposal.
1t you have objections to what is being proposed, you must notlty the N.C. Division of Coastal
Managomont (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
molted to 401 S. Griffin St., Sto. 30o, Elizabeth City, NO, 27909. DCM representatives can also be
contacted at [phone]. Me response is considered the some as no objection if you have boon
notified by Certified Mall,
WAIVER SECTION (Choose oniv ono)
I understand that any proposed plot, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back o minimum distance of Whom my area of riparian access unless waived by ins
(thinidoe not t npuly r i r kh ad r it r o at t ). (If you wish to waive the setback, you must elan
the appropriate blank below.)
1 00 wish to waive sometoll of the 1 a setback —
Signature otAdjocont Rlpadan Properly Owner
-OR-
1 00 NOT wish to waive thu 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/printed name of ARPO:
Mailing Address of ARPO:
ARNO's imtall:t'1') i
Data: 1 a 1--' txal
Phone#:,
waiver Is valid for up to one year from ARPO's Signature'
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CgRIT191) MAIL RETURN R QUESTED or HAND'a)ELIVERY DEC 14 2023
(Top portion to be completed by owner ( r their agent) D Cfl� Aq C
Name of Property Owner.
Address of Property: ) ti
Mailing Address of owner: ' fig
owner'somoii:Tti'1�1n f'r� ��YT> S4i•� kab+ Ovmor`sPhoneH f � `� >zjJ`t���� t7� }'J�
Agent's Name; tDr(v"o-l�C�eYCtoPrrv� AgontPhonoff:�t1�� c�ItS�
Agent's Email: 9, f lkr�_ b(d i ry �r� oft-'Cil>dk POi� t
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom eertl2n to bo coMI)hnigd by the Adlaoent P(enerry Owner)
I horeby cenify that I own property adjacent to the above referenced property. The Individual applying for this
pemtit has described to me, as shown on ilia attached drawing, ilia development they are proposing. A
jLs�rjpnnn nr r rawinn with dimensions must as arQYld6d `it tt latter.
I DO NOT have objections to this proposal. 100 have objections to this proposal.
1% you frave objectio»s to what /s being proposed, you must nodfy the N.C. Division of Coasfat
Management (0CM) in writing within 10 days of rocalpt of this notice. Correspondence should be
»railed to 401 S. Griffin St., Ste. 200, Elizabeth City, NC, 27909, DCM representatives can also be
contacted at [phone], No response Is considered the some as no objection If you have boon
notified by Corlifted Mail.
WAIVER SECTION (Ciiaogg 1n v ono)
I understand that any proposed plot, dock, mooring pilings, boat retail,
breakwater, boathouse, lift, or
groin must be set back a minimum distance of 1 from my area of riparian access unless waived thyme
(this deos net apply to bulkhaatts a�rioraa revalmonts). iif you wish to waive the setback, you uet1/ R elan
the appropristo blank below.)
1 00 wish to waivo some/ail of the 15' setback
Signature of Ad%aConarion Property Owner
•OR-
1 00 NOT wish to waive Ilia 15, setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
7ypodlPrintod name of ARP^: t �•'{` CVC"`
Mailing Address of ARPO:
ARPO's
i v� sl l�v � � r- r i • I (rr I �, )c: Z / i` �1 ``)
Phone#:
h �
Date:-) waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

RECEIVED
DEC 14 2023
DCoM-EC
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