87209A - Lambert, Erin

°�°"°""❑CAMA [IDREDGE & FILL NU 87209 A B C D
Previous permit V
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:
15A NCAC I \i ( ( Up ❑ Rules attached. E' General Permit Rules available at the following link: vvwwdeq.nc goy/CAMArules
Applicant Name G Y r: N % 0.11 ),s t
Address Ii1_n Wit olo—i Po�nV tloo ,)
City (. c(aState NC. zip c(;#,
Phone #(IliD) ({O'S 0 5 gq
Email eO 14' ,.)lax � )nJ & zdmA Cwr.
Authorized Agent
Project Location (County): 0 1
Street Address/State Road/Lot #(s)
Subdivision H0 Al Ili r
city F t. •,F.,,, zip 3"
Affected ❑ CW MEW ❑PTA MES © PTS Ad!. Wtr. Body A 16 w c / (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body -
ORW: yes/no PNA: yes/no
Type of Project/ Activity 0
i tc. 1, I :"46 (Scale: pl )
Access Length
Pier (dock) length
Fixed Platform(s)
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Floating Platform(s)--
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avgdistance off5&re ? ,
Breakwater/Sill
Max distance/ length �'
Basin, channel
Cubic Yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
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SAV observed: yes no
Moratorium: n/a yes no
Site Photos: Yes no
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A building permit/zoning permit may be required by:
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),Y
or Applicant PRINTED Name
Permit Officer's PRINTED Name
�f
Signature•*Please read compliance statement on back of permit" I Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN Rr rrcroT
(Top portion to be completed by owner or their agent)
Name of Property owner: '• r1
Address of Property: �((or,n', ��ti n r r
Mailing Address of
Mr
Owner's emaill,
`` ,� r -t �tr2�mr�. C +Owner's Phone#: �4l? Rp3 C�7a
Agent's Name^4--1,1CTh, _
Agent Phone#:�o13_
Agent's Email:-'�►�gw•p t'YP�.itrlr:C�-:v-�,:"..�.,. U_ �=--.. t
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent PEOPerty 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
tl�ription or drawing with dimensions must be nrnvided with rr,r� 1,,41 -
I DO NOT have objections to this proposal. I DO have objections to this proposal.
Myou have (DCM)ons rl what /s being proposed, you must notify the N.C. Divislon 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 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprao revetments). (If you wish to walve the setback, you must Sian
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank) &
Signature of Adjacent Riparian Property Owner:
Mailing Address of ARPO: IULII l,l ) Qkalkir aWTi" M j-(.C' v7�-1•
ARPO's /email: {_ A PO's Phone#:
Date: or= d`7 • p2� •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 NOTIFICATIONMIAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: �J/ N L�E072�?
Address of Property: ��� t+la/Ir t )� C .`dl �TOnI 2 3 a
Mailing Address of Owner: ij�p �1�2a/rQLdC� �NT �� �1T01 � /(�C2%j3
Owner's email:9—eI� l `l f tntt M�trl•c,Owner's Phone#: %W �3 ° OM
r, Agent's Name: 12 �-�4,r,.�,�S�eutc-2_ Agent Phone#:2.S2. 331 U27YI /
Agent's Email:xiy� a Lc,"
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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
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. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response Is considered the same as no object/on If you have been
notified by Certified Mail.
WAIVER SECTION (Choose only one
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' 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:``t!" 2� �—
Typed/Printed name of ARPO:
Mailing Address ofARPO:
ARPO'semail: plc\�6�1`{tmJet;tlo, ARPO'sPhone#:n3"b) t.,90-cl"1��j
Date: -), t `f k2i 'waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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