87178A - Kersey, Joseph and Kristen

D"LAMA ❑ DREDGE & FILL N9 87178 A B c D
GENERAL PERMIT Previous permit
Date previous permit issued
F 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. ❑" General Permit Rules available at the following link: www.c1ea.nc.zoy1CAMAruIes
Applicant Name I <, c-I
Address
City State ZIP
Phone # (_ )
Email
Authorized Agent I.. - . c'r M o_ c t P. nc. I� A'`5
Project Location (County): (' t)< r- 1 fI J c k
Street Address/State Road/Lot #(s) i (6 C.:•r rrot C7 3 O V't
Subdivision
City VsCL_Cc_c> zip—,;,) .7 9 (ter
Affected ❑ CW
❑ EW ❑ PTA
❑ ES
❑ PTS Adj. Wtr. Body C. O t N3 s:?Gk G A (�:A*nan/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW
❑ SPIMA
❑ PWS Closest Maj. Wtr. Body 0 U
ORW: yes/ho.
PNA: yes/no
Type of Project/ Activity �7LJ l `c4te ate%
(Scale: f
Shoreline Length 'i r
Access Length
Pier (clock) length
FixedPlatform(s)
1
�
111
-
i
I
77
-
—
_
+�•
`�"
Floating Platform(s)
Finger piers)
Total Platform area-2,
5_
Groin length/q
-_.—
Bulkhead/ Ri ra length 'i=. I L
Avg distance offshore
Breakwater/SillMax distance/ -length R: •, ,-
Basin, channel / i
Cubic Y
Boat ramp
`"(
T'q
—
--
Boathouse/ Boatlift �—
Beach Bulldozing
_.)
Other
-
I
`
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F'0
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SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
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A building permit/zoning permit may be required by: i iC_ (. G a1 o 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. (Please Initial) UOt
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
,r,
Signature "*Please read compliance statement on back of permit" Signature
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ApVlication Feels) Check N/Money Order 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:
Address of Property:
Mailing Address of Owner:
Joseph & Kristin Kersey
164 Simpson Lane, Barco, NC 27917 - Currituck County
815 Falls Creek Dr, Chesapeake, VA 23322
Owner's email:
[e-mail] Owner's Phone#:
757-434-5170
Agent's Name:
_ flap f� n -/n Agent Phone#: lb (3
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Agent's Email:
LW4Jkntnu(,f2.. ^� 0011 • O m
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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
description or drawing, with dimensions must be provided with this letter.
-D4V 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. urwsion or coasral
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 sinn
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signatdre 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: L�� 1,2�
M
ARPO's email:ARPO's Phone#:
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f r.
Date: ' . �%I J 'waiver Is valid for up to one year from ARPO's Signature*
p Revised July 2021
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10 S+ i�o SIt Smr LdR4
(bo1Co, NC 7'1)RIr1

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: Joseph & Kristin Kersey
Address of Property:
Mailing Address of Owner:
164 Simpson Lane, Barco, NC 27917 - Currituck County
815 Falls Creek Dr, Chesapeake, VA 23322
Owner'semail: [e-mail] Owner's Phone#:
757-434-5170
Agent's Name:
Agent Phone# �L. `!//� Q,
-' 4 3 '1.s
Agent's Email:
IGU FYlI�{ii=�� �tl�,
rr'dittrro l >;n �Y(�tt'rg
�uos}iyc?lc
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
dgpgription or drawing, with dimensions. must be provided with this letter.
J97—O', 1 DO NOT have objections to this proposal. I DO have objections to this proposal.
it you nave objections to wnat is oeurg proposea, you must noury me im— urwsron or coasrai
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'
lD
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner,
Typed/Printed name ofARPO:. t �U�1L2 di;- f((G'tI'-4Jfk i ��CJrltt,�/
Mailing Address ofARPO: ,�-tJ�s'-� ti('f�/i211 /'`,,G.�iY.(y.
ARPO's email: 1,JbkKS6K 4?1 fK ARPO's Phone#: ,', 7- r! f 9-11 5 3
Date: 1 _.: i *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
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