87198A - Melker, Susan

❑CAMA ❑ DREDGE & FILL NO 87198 A B C D
GENERAL PERMIT Date re 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. ❑ General Permit Rules available at the following link: w Aeq.nagov/CAMArules
Applicant Name
Authorized Agent
Address
Project Location (County):
City -
State ZIP Street Address/State Road/Lot #(s)
Phone # O
Email
Subdivision
City ZIP
Affected ❑ cW
0 EW 0 PTA ❑ ES ❑ PTS Adj. Wtr. Body Ai (nat/man/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no.
PNA: yes/no
Type of Project/ Activity
(Scale:;
Shoreline Length _
Access Length
Pier (dock)length
Fixed Platform(s)
to
�
r-
7
0.
e
i�
�
—
if
+.
;
—
_
�t1
il
tr
Floating Platform(s)
Finger pier(s)
_I
_(___
-'
r•-
- --
Total Platform area _._.
Groin length/71
Bulkhead/Riprap length
Avg distance offshore --I�
Breakwater/Sill
Max distance/length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
r�
..
._
'
__a."
._".
---
--
--
--
T
-
/'t —�
ri
'-,
----
SAV observed: yes
Moratorium: no
Site Photos: - _�'.
Riparian Waiver Attached: yes no _' �_._..
i
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A building permit/zoning permit may be required by:
Permit Conditions
"HAT APPLY TO THIS PROJECT AND
Agent or Applicant PRINTED Name
Signature **Please read compliance statement on back of permit"
Permit Officer's PRINTED Name
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
k
(Please
Signature '
11/, )zl /z ,]
Issuing Date Expiration Date
Application Feels) Check p/Money Order

AGENT ALFTHORIZATION FOR CAPERMIT APPLICATION
Name of Property Owner Requesting Perms N ( I e Q1,
Mailing Address: t q© S W A u 1 C t C P01,01 112 ev& R Z W 6e,q
Phone Number:
Email Address:
I certify that I have authorized
Agent r Contraaor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:
at my property located at i tlb � i W A ti G iR L t lip i N T YiA (gyp ¢
in C-UZV tTUC K-County. j-
1 furthermore certify that I am auflwrized to grant, and do in tact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
S' atu+e
Print or Type Name
-)Y Y
Tifte
Z r 2ti r u2�1
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATiONf WAIVER FORM
C90-1I�IEO lAA,})�RETIVR_N RECt: T RF.QUESTEO or NAND DE.NERY
(Top portion to be Completed by owner or their agent)
Name of Properly Ownet,--&SA AS ME'L Lrl"
AWress of Prapnrty: �t{0 +J Aril �l'nSri, ., 't-'d t� ^+T� t �} 5t�-!s%C 'Z'7 Li
Matting Address of Oasrer y
Ownen'semail _ _ Owalppr'a Pexna#-. L-iLtta _.U`LS - 4433
Agent's name,: _ i_ L'r�j�`�j.�,...7y rgont Ptgrtea:uZ5` "4' 2U2'_7q j
Agent's Enw!t �t rvr�oy. Cal ha '. Go n"
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Dettom option to he ComWeted 6,�thg,�aaf{{Prgparly Ownetj
I hereby.&Ay that Iowa woony adlacem to the above retoronrwd property. rnu IpdmW uai oWhnng for this
penes has d9gubed to m0, oS YhtV01 4r the Allocnod drawing, the da%%tuP nt Ihroy am proposing. A
4 � w� rrmnsions t'Nrst R§.as�gg9xh2tinlst+ -
__ 16D NOT have uleectgin t4 )his Im pusal. 1 DO i; ava objedlone to dile prcposol.
N }vu' bare obJasdons fo what Ja�berceg wropixsed, y'ou must now ow wa—&"ri-W Cmxfa!
A9arrapenrord (OCMJ in writing WA M 40 mays of MCNpt of this notice. C rmspondanoa sh"Id ba
WINVid to 401 S, Griffin St., SIe. 300, Vizabeth City, NC, 27eW. DCM ropmemeta0v s can also be
Contacted at (2$2) MA -MC No response, is considered the same as no objection H you h.. been
"tMed by Cer}fRed Mail.
WAIVER SECTION
I undemua.vf grist v,:y ;ucposad pier, dais, mounrg pi airs twat ramp, b,oakAa,r, twatt tws, lift, (v
W-0 rratst be set back a ndrpmum c wtu(rca of IS' bom my of. of urns t n eceess unless waived oy mu
(BNa does rrot apply 10 twlkneads or ritimp revoArentsj- (if you wish to waive Igo sarbedc, yuu must stun
one appropriate blank ealbR.0
5 DO vAah fowaira sumatati pf the, 1S setback a % 1(
-0ft- Sajnaturo of Aid rzyarian Pn�Psrli' (.`wnsr____.-.___.
i do not wish to waive fha t$ sotbagc mirWmr nt (ini(iaf the
-,}r3ignnturo nE hdisCsnt RlPan4n PrOpm"t{Y''Gsnar: 'd.,��.Ga.--"''~�.. /
- Typsdi ranted name of ARPO: ,_Sj u,�v Gel+/L{ �_��_...,._..._...,_,_,,._ ✓
Matting Address of ARPO: �"—
ARPO'a emaU: -- ARPO's Phone#:
Data: � � _ �' r ,,,,�'waivoe to vatkl far ap to orw year from ARPO's Signature`
kevAsed.luW 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIOWWAIVER FORM
CERTIFIED MAIL-�fiJNN REQEjf�Ttj (;tgE_gEQor tiAN 6NERY
(Tap portion to be Completed by owner or their agent)
Name n!Prapady Owner.._-ASA,hS-{� 'l NI i._-.._---...__---_..__-__.._
Addressaf Pro," 141A �>Ujl
Madra,} Addren at Owner
OwneraamaA- __._,.._.,_.__OvmarePhantR-1"��u-`tf"2$-LtLlj3
Antlers Fame; Ic,T" ft �N Ti�
�/3:�ADentPnoncu;_..�5=--
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICAI ION
r n to Co a hied b tF$Ad7aw t PraoaM Ownery
t hereby vxlOy Uiaffawn pt ad}arnnt to the ubcle referenced property. The irdmuuP,pp ug iw Utf9
padesr rmlt has xRed ne shbwn G the attached prn Bing, fine devWpmant they are prupusing. A
"-Ut3'±le1�e�[ Ap4�4�^^a m .iL§gsrv„idm wm, mrs,.
t1f} NOT $a-ra obiecsgns to fide propasat ._ r CO Lwe olspneous fo this prxosat
rf you7iaro objsctt`ana towtrit 1s De)rrg proposed, you must notify Me N.G. plrtzton of caveat
N aplar front (OCM) ht wNhng wtmin t0 days AT WOO at this Purim CuuVSPoadefxo should be
Prayed to APt S. Gri ffe St, SIC 300, Elizabeth City, NC, 2790 , OCM raptosantattros can also be
contacted at (252) W4.3901. No response Is consWeaM me same as no alyectton N you hove boon
.*tined by Confined Ma l-
WAIVER SECTION
I uAderstand that any proposed Met, Dad. nu„flq plGngs, puat rump. Mookwater. f ,,adnuse, lih, to
groin must be sot track a Inuanum d,st my of iS Iroe1 my Area of rfi,anan access w4ass wahod by me
(this door not spwy to bulkheads or riprep;evetmonis}. (If you wish to •xaFm tha Sn Iex k, ynu must Sip,
the opprW rfale blank bekfw.)
!t50 wish towaive samn;a![of tiw!V,.tbsch r,( A do not wsh to waive the ib° sod,ack rottuuement (9ntiaf the
jt"Signatu±o at Adlacer+(Rparign.isropany Omrer
� TypotltPriMed name nt ARf+O: J—--L11_ztl _ . __+yryL���
Marling Address of ARPO- �// .~_.__�...._.._
ARPO`s emu 1)� �131(K. 4—To R®P •s Pall" 1_ 'j �`_] -{�+ Q'7153
Date: .,„ `waiver is valid for up to one year hnm ARM* Sigo Wow'
Revised July 202f
Agw,iI khi43�+
Heir -to rproycrr4•t vtq ExPCitov ®T
Esc -Ue �-A 14oIIeh.

AAA )' Ullck "Ow VIA,13kt
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONM/AIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. J ,k S i-� 0 Yy1�LK,l`t'Z_ �7
Address of Property: �L{b -6VJAJ\i cl,(LC-lC p0%NT
Mailing Address of Owner: r / c /
Owners email./ u- k-/1 � !2 S/'1 PA ° owners Phone#: L� Ue —V S--- N u 33
Agent's Name: ZO&O T ,10o !r6 r Agent Phone#: O`Z 3
Agent's Email: J�CiL1!/J/�.Q'1,414pU CO/Y\
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 drawine with. dimensions must bg provided with this letter.
Zl DO NOT have objections to this proposal. _ I DO have objections to this proposal.
0e
tad
Management (DCM) in writing within10 days of receipt of this notice.� Corrrespondefn a shouldon of bemailed 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
noted by Certified Mail.
WAIVER SECTION
1 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.)
DO wish to waive some/all of the 15'setback ,t,a /
!v �q" q �.5- Y
Signature ofAdjacent Ripadan Property Owner t `^' � -• 4 t '-,
-OR-
I do not wish to waive the 1T setback requirement (initial the blank) _ .S �% " MAY 2 4 2U22
Signature of Adjacent Riparian Property Ownetr , �.N. ryht4Up t � I t ! B N to
Typed/Printed name of ARPO: JIA.Z t1tC'11-.1VJis11`,,I %`� r1 Lit„ 5,19
Mailing Address ofARPO:-40�v� TU_ltill"1CC:OK k& N &e adGl�
ARPO•serif'aR� W\CCL(A LY4il cdrvc�i�.0 ; 1 �/
"�J ARPO'sPrhone#:��:�'��'�� \ 0C)g
Date: _�. _]—o�O�veiver is valid for up to one year from ARPO's Signature -
Revised July 2021

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