87112A - Tant, Timothy and Joan

GENERAL. PERMIT Date Previous
fazxe previous permit issued
®New ❑Modification ❑Complete Reissue [_]Partial Reissue
As audiwrized by OaStof Noah Carolina, �pa�nt of Enwonnnental Quality and titsf oanal R*sourc•s C*ffuWssson to an area of urdroronmtei concern ponuarno; t
l.i4 NCAC a7e4' IOU'_ nubs aauhod. ® General Perrrit Po&s available at dYe tdlowirlg ard,:
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Affecrmd [ltw. EXJ £w M PTA N £s Q M All, Mr. e«Ir _b� P'ttr@a- Ql�n,ar
aEcta>: ❑ oea ❑ teA ❑ uW ❑ SPIMA ] PWS Closest Maj, wa soay �1 t 4ema,<-"tllrsd
ORW: yes/np PALA. yes/no
Type of Project/ >haf*y
Access length ^ , �""
Pies (dock) length
fixed Plztforaw(s)
Floating Platterm(s)i
e
ranger pter(s)
.... fir,
Total Platform area n
Groin length/if'-''-----
uikho Riptaplength
AY dt"ce offshore
disance/iength _._,. -..�..
I, channel
:yards �..
ramp, _ .
r+r i. Jill
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'SAV observed; Yes
Moratorium: no t t
Site Photos:
.kl,, I'--�i
Riparian waiver Attached ims �F.„&t } *....L....,:.-:,.' -a.-,
Abuiktlrsgriermtt/roningoetmitnebyherequiredbY;._. a►. (�,.
Permit coed tfons _ _ x
0 TARJPAtVVNEUSFAUFFER(chc4
ElSee note on back regarding River
0 See additional notes/conditions r
i8 AWARF.DESTATUTESCRCRULESANDCONDMINISTHATAPMTOTHISPROJECTANDREVIEWEDbi7MPHAN"STAIEM£NT. (PleasohtRial)
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nrrnntorAoollcantWItMIJName Permit vPI!IUff0Name�
fignature"Pleasc�adwmplianccstatemcntonbmckpipermlt•� _ Signature

duluzu ®CAMA [$J DREDGE & FILL
�) GENERAL PERMIT
N° 87112
Previous permit
Date previous permit issued
Q B C D
® New []Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State I of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ?44 ` I (CTG ❑ Rules attached. ® General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
City F_i,,-txLb 4'r, C`j,4 State NC zip 2 /9V1
Phone #�+(,10) (0Z0—`f�
Email T`FOLr1�Q Qr k CCtct:�'Y21t,Ce . cc zn'
Affected ❑ CW EW PTA [XI ES PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
0 nr.,nx. N—..6
Shoreline Length � I:
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/k
ulkhe / Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length S
Basin, channel
Cubic yards
Boat ramp
Boathouse/ BoatliR
Beach Bulldozing
Other
SAV observed- yes KZ p l
Moratorium: (yq_� no
Site Photos: TE?.J qp
Riparian Waiver Attached: yes (�
A building permit/zoning permit may be required by:
Permit Conditions
OF STATUTES. CRC RULES AND CONDITIONS THAT APPLY
Agent or Applicant PRINTED Name
Authorized Agent
Project Location (County): ?cLs f cabaA k
Street Address/State Road/Lot#(s)
1y93 NiX04On Fcl.
City
;2I9 ©9
Adj. Wtr. Body_ 1�i- f k: t Vier at an/unk)
Closest Maj. Wtr. Body A I bej 1, l to .](7 (nir�d
VL he.Mo`rWt
k C
Name
W'A
N?J )
Abr 3�
RY K Ce4 j__fr.rs,�
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature**Pleasgad compliance statement on back of permit** Signature Or
$ `lc� CC lall I� 2Drz 3 14/2ol2y
Application Feels) Check q/Money Order Issuing Date Expiration Date

❑CAMA ❑ DREDGE & FILL N9 87112 A B C D
GENERAL PERMIT Previous 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 ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name —
Address
Ciry
Phone # O _
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: N 'J )
chn.olinn � nnm6
Access Length
Pier (dock)length �
Fixed Platform(s)
';
-�
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I
;
,�
�
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��
-
--�
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/Jt
Bulkhead/Riprap length -�--
l
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp-
Boathouse/Boatlift
Beach Bulldozing
Other
!
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_
'V
)
—
-
�y
—
--
-
—
-
-
-
--
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-
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"-
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_--""_
-—lt:.•
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—
-
-
_
SAV observed: yes no )—
Moratorium: n/a yes no
Site Photos: yes no '-1
Riparian Waiver Attached: yes no _ _i
L
l
t
--
-
U
--
—
A buildingpermit/zoning zonin q y: f I
p / gpermit may be required
I
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 Permit Officer's PRINTED Name
Signature -*Please read compliance statement on backpf permit"
Application Feels) Check tt/Money Order
Signature
Issuing Date
Expiration Date

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: // � 9� S_,Co, Q✓
i,� •�
Address of Property: 'f 9c? �V /Y O�"/U ni IZt7
Mailing Address of Owner:
Owner's email:
Agent's Name:
Agent's Email:
'7a7-6ZO-8746
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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
notilled 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- /
1 do not wish to waive the 15' setback requirement (initial the blank) Tr%N
K
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARM )) AAS
Mailing Address of ARPO:
ARPO's email: 1"OIMN/i'SN 11�,�tiMlBh PO's Phone#: e?!%? ' ci�Ja% elf% rf2L
Date: 7i I 1 7 1 tgog7 � *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: ;s
Address of Property, t�� + ���°PP #tom°'t��+ r`• °� dO e
Mailing Address of Owner: &at, 1g `if Nd- z;`',�kb fa
Owner's email: Owner's Phone#: W>+'^^
Agent's Name:
Agent's Email:
iy?i+4
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certi fy 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.
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 notay the rv.c. urwston or (,oasrat
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: 5 1-rtlew /i mil=-V i (f%i1 1?1
Mailing Address of ARPO: 30 u� /Ue ! 1 LI�(/�% f S % Gffl N i By NG 27`15 f;
ev, cd^
ARPO'semail: SWlr�til/�I W417,f1AOI ARPO'sPhone#: 2h2-6K2-21��-
Date: 6i gip! 2ZO2 3 'waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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