87144A - Hardwick, Scott and Melissa

.+°`teA"',N[�CAMA P DREDGE & FILL N9 87144 A B C D
a� Previous permit
GENERAL 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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdecinc gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
State
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES 0 PTS Adj. Wtr. Body (ngt1man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/rio. PNA: yes/no
Type of Project/ Activity
(Scale:, 'i S. )
Shoreline Length
Access Length
Pier (dock) length
Finger pler(s)
Total Platform area
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Groin length/tt—
Avg distance offshore
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MEMO
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A building permit/zoning permit maybe required by: 1 oSn . ),14111C C ,- �, y
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 statement on back of permit** Signature
Application Feels) Check#/Money Order Issuing Date
(Please Initial)
Expiration Date

RECEIVED
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM FEB 8 2024
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY 0
(Top portion tobecompleted by ownerortheir agent) DCM-EC
Name of Property Owner. SCO J 1 Mt:(i55 n �7A/Ut^ 1t/l
GG,
Address of Property: 3OD S uitt l t D/ F Vz . O •r`�y tic- 10'2 CI V
Mailing Address of Owner: S pm e
Owner's email:
Owners Phone#: o"1$a.- 3`-Ie- Sjl ,3
Agent's Name: Lct!yde+i
"r9^ nf—n
Agent Phone#:aS >'
Agent's Email:
LCc*146
n/VJAr) ^Q�l17�7
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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 adjacentto 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.
It you have objections to what is being proposed, you must nobly the iv.u. utviston or r oesrai
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.
u7J[T#[IFJ;kQtllL@ `'
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 si
the appropriate blank below.) _ -�
I DO wish to waive some/all of the 15' setback
sm
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:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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RECEIVED
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORMFEB 0 8 2024
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) OCM-EC
Name of Property Owner. 5C0+4- i r-%8t S319 6ln/41-1 GA —
Address of Property: 3�l) Sri 1 t l%/ 1%� �2, 0,I tic, a Q q U
Mailing Address of Owner: S i9r rl o�-
Owners email: // Owners Phone#: oZ �✓a " 3 " f G - S/ / 3
Agent's Name:Lasb/En tVIa ino0TnL Agent Phone#:,i5, --331
Agent's Email: LLt Ide'l rye'"A
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto 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. Grim St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 2643901. 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.)
DO wish to waive somelall of the 15' setbac� Ni31 fjM F, 420 Uf JiA'LC7 iLS
rgnature 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:
ARPO's email:
Date:
ARPO's Phone#:
'waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

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