87173A - Daughety, Robert

#F-]New
OCAMA ElDREDGE & FILL No 87173 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑ 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 ❑ Rules attached. v General Permit Rules available at the following link: www.dee.nc goy/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City ' State ZIP Street Address/State Road/Lot#(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/marl/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no.
Type of Project/ Activity
(Scale: 11) )
Ghnralina lunafh I/
Access Length
Pier (dock) length
Fixed Platform(s)
ME
ONE
Floating Platform(s)
ONE
Finger pler(s)
ME
Total Platform areaGroin
length/#
8
MillME
0
MEN
NEE
0
ME
NEE
MEE
�s
311
SAV observed: yes no
Moratorium: n/.,) yes no
Site Photos: yes n i
Waiver Attached: yes no, i
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L:Riparian
A building permit/zoning permit may be required by:
Permit Conditions
( Ok, ,,
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
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 back of permit** Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

Agent's Name:
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED ar HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Ow
Address of Property:
Mailing Address of Owner. / Z / a n v N (� i i/ ^� e �4<<'Pfr' i� 2 3 vsR/
Owner's email: �,c2T�s.(" h p^ei�'-ul O'ner's Phone#: 7S7 - G 3 e -e 21 10
C'o 1 n-tt'
Agent Phone* i
Agent's Emil:
INUM --
023
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 apg forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
dosatot on or drawing wdh dimensions must be provided w th this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
it you have objections to what is being proposed, you rmm, nuuly
Management (DCA9 in wrkffng within 10 days of receipt of this notice. Correspondence should be
waited to 401 S. Gdffln St, Ste. arm, Elizabeth Cfty, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection fir you have been
notified by Cerifffed A9811.
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 15' from my area of riparian access unless waived by me
(this does not apRN to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.) //1
I DO wish to waive somefatl of the t 5' setbaclk --
Signature of Adjacent Riparian Property Owner
-
OR-1 DO NOT wish to waive the 15, setback requirement (initial the blank)
Went Riparian Property Oy+ne of ARPO: J �r/1 ig 1L. E/�f APO:
CY"+y
ARPO's Phone#:
AX -? 7 1�y�
^waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONAMAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or NAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner.
ddress of Property:
Mailing Address of Owner: / 4?, Gan 1 r L t'- i1 f�- ib -e- - 6-�- ' t%/4 —7 3 15
Owner's email: � nees Phone#:
Agent's Name: _ Agent Phone#: R L_ U ,
Agent's Email._
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION �c
{Bottom portion to be co�d by the Adjacent Praparty Owner) iete®t,vr�Olx .,.
I hereby certify that I own property adjacent to the above referenced property. The individual applying For this
permit has descdbed to me, as shown on the attached drawing, the development they are proposing. A
100 NOT have objections to this proposal. I DO have objections to this proposal.
It you have Objections to what is being proposed, you must notary tine N.C. Division of Coastal
Management (DC" in writing within t 0 days of receipt of this notice. Correspondence should be
mailed to 401 S. Grain 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 ontv one
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply fa bulkhads ar rirap reve>tments). (If you wish to waive the setback., you must sign
the appropriate blank below.) f, _. >
DO wish to waive somefail of the f 5' setback - 1 —1!
Si'_WtVt6re or Adjacent Riparian Property Owner
,OR -
I DO NOT wish to waive the 15'setback requirement (initial the blank)
Signature of Adjacent Riparian Property
r..nnrtlori r,anri .aama of ADOC%-
Mailing Address ofARPO: 75/ t °�2tjC C/tL�r1t /'(-Xi2,
ARPO's email:iGvril'.ley ' `t' um ARPO's Phone#;
Gate I � 3 -waiver is valid for up to one year from fi RPO's SigratUra°
V4
Revised August 2022

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RECEIVED
FEB 0 0 203
DCM-EC