87100A - Tilett, Douglas and Julia

&"Vwr" ❑CAMA ❑ DREDGE & FILL N9 87100 A B C D
a 114
GENERAL PERMIT PreDate epSperm``
� previous permit issued
Q 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 i ' ' 7. -• " ❑ Rules attached. , ❑-General Permit Rules available at the following link: wwwdeq.nc.gov/CAMAruIes
Applicant Name
Address
City State ZIP 2�;/
Phone # ( )
F.. H
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
/ 1
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PINS Closest Maj. Wtr. Body
ORW: yes/rio PNA: yes/no
Type of Project/ Activity
(Scale: N ►
c6nmlinn i anarh
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
■
■
■■
■■
Finger pier(s)
Total Platform area
Groin [ength/#
Bulkhead/ Riprap length
Avg distance offshore_
Max distance/ length
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ME■■■■■�
NO
on
INSOOMMEM
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so
Basin, channel i
Cubic yards
IN
Elm�IN■��1
mom
Boat ramp■I
n
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■■■
�■■■■■■■SEEM■■■■'
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Beach Bulldozing■■�
Other•
MOM
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.
Moo
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SAV observed: yes no
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Site Photos: YeS no
■■i�■iii�i
ii0■Riparian
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Waiver Attached: ves no i
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A building permit/zoning permit may be required by: �Z> a r 2 C.
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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature"Please read compliance.1stat�menton back of permit** Signature
(Please Initial(
Application Feels) _ Check#/Money Order Issuing Date
Expiration Date

'Dnc K E7C rf.;. N S 14f
/7 oF� r50 riaA A -

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: t oU6 1 t 1- l-ET T -
Address of Property:
Mailing Address of Ownei
Owner's email: 7CUG-P(,SSG(ir1LE�L.Cof10wner'sPhone#:�252) �� U�
Agent's Name: 1N/,4 Agent Phone#: N.114
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
1 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 (Choose only one
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 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: & 2G(4�r�-✓%1`-1 M C: 29yS7�
c«r�
ARPO's email: crs y" 0 ARPO's Phone#:
Date:.rL` i L, Z023 —*waiver is valid for up to one year from ARPO's Signature,*
Revised August 2022

N.G. DIVISION OF COASTAL MANAt36MENT
ADJACIINT RIPARIAWPROPi RWOWNER NOTIFICATION1
M PTIMCn AlAil n&VI,n L, ---- _.. -
(Top Portion to bo completed by owner or IheIr agent)
Name of Property Owner.
Address or Property;
Mailing Address of Ownei
Owners email li uC I LSS DTIC UL("towner's Phoned:
Agent's Nartm: -- NSA -I Agent Phoned: N�r�
Agent's Email
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(gattSM portion to o coM otod b the Ad acont Property ovAnor)
I hereby certify that 1 own property adjacent to the above referenced property, The individual applying for this
Permit has described to me, as shown on the altachod drawing, the development they are proposing. A
1 OO NOT have objections to this proposal 100 have objections to this proposal,
if you have objections to what /s befog proposed, you roust notlry tthe N,C. Division of Coastnf
Management (DCM) in writing within to days of receipt of this notice. Correspondence should be
mailed to 401 S. Grffrn St, Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response Js considered the same as no objection if you have bcon
nodfled by Centred Mail.
WAIVER SECTION (Chooso only o o
I understand that any proposed pier, dock, mooring pilings, beat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15from my area of riparian access unless waived by me
tf does not oggly to ulkheads or riprap revetments). (If you wish to waive the setback, you tust alut
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
Signaturo of Adjacont Riparian Property Ownor�
-OR-
if DO NOTwish to waive the I5'setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
7yped/Printeld name of ARPO: SUh _ S
Mailing Address of ARPO; U . 13 o 5z S��E _f— �+ '� O i O.
II..' t,6"
ARPO's email: r`�;ri f f1I 04u tl�ARPO% Phone#; w�Q 60 Z d
Palo: j � �� � "waiver is valid for up to one year from ARPO's Signature`
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