87210A - Heath, Frank W.

M1tW741 �CANA $ DREDGE & FILL N9 87210 QB C D
IGENERAL PERMIT Date prevouslpermit issued
[MNew ❑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 �-µ, 11 O—11!tules attached. XI General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name i'ru /s IC W . i4cc."/-k Address Ila/
, eayl (5..+�r nl/y r`n
oa�
City late K'I cl State NC_ zip ;k11' L#L1
Phone #(tea-) 4ST &I
Authorized Agent VIA
Project Location (County): Fe CV, r .n S
Street Address/State Road/Lot #(s) 11'1. EGSi Cr.op PC r/1
Email (O+ga.l. C.v Subdivision O (''rsypejl
city ucrt 4 r ZIP a'49 414
Affected ❑CW QqEW PTA OES ®PTS Adj. Wtr. Body pfAvi sr �nan/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 1�t ✓ z ,... ,..� 2 v'L
ORW: yes PNA: yes
Type of Project/Activity ±)OSof l3oIY_,c�J
Two s�i- twx,s}
2) 11LIuo J (CIS. rntc,,vr-t J
(Scale:NT,j )
Shoreline Length �XO
Access Length
r
Pier (dock)length
Fixed Platform(s)
k*
o,cr': QIo-�4t,tr
Floating Platform(s)
n
. 1"trpWlrvw nl R'�/'
Finger pier(s)
Total Platform area L' t-
K
L/t
Groin length/#
f
ulkhea Riprap length =\OS�
J
hvi'1wr. K� 13v\�Gh+r-d
+, dl`rl n+sun
Avg distant offshore ci.t
_4
lei ,
Breakwater/Sill �
/
Max distance/ length
n Bit
Basin, channel T• `
` — -- + --n �� @ prw -
Cubic yards
CIA
I1l-
� it —
Boat ramp
iSu\Y.k�r
(D Uwt
Boathouse/ Boatlift
, I_
Beach Bulldozing Ovt.C%.
,A u/ me rt -(pc1}
Other
eX Rs(>foP t..•-41an2� \✓ 1„�1�`
h
SAV observed: yes (
Moratorium: ® e no
�
Site Photos: no
Riparian Waiver Attached: yes etp
((��
A building permit/zoning permit may be required by: Pe iG
v , sna n
1 `i�u ,r ��
❑ TAWPAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ 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) )C
�ent or PPlicant PRINTED Na eor pplicant PRINTED Na e
T�
Signature *'Please read compliance statement on back of permit"
#1­100.00 X't 4aj!>
Application Feels) Check #/Money Order
Permit
31)4�J.v.14��ld . Da4
Issuing Date Expiration Date

[]CAMA ❑ DREDGE & FILL N9 87210 A B C D
GENERAL PERMIT Previous 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: www.deq.nc.gov/CAMArules
Applicant Name I Authorized Agent ➢✓!/'
Address Project Location (County): ('
City State ZIP Street Address/State Road/Lot #(s)
Phone # (; )
Email a..�—' Subdivision 0 P:-
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity - a
(Scale: ij 'r, c., )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s).
Floating Platform(s) T
Finger pier(s) T
Total Platform area l
Groin length/# !
Bulkhead/ Riprap length } US
Avg distance offshore?�
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other !
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
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
AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
r
Agent or Applicant PRINTED Na rpe Permit Officer's PRINTED. Name
Signature —Please read compliance statement on back of permit" Signature
Application Feels) c_. 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: RCRTFoRD NC 279'�4
Owner's email: _ %r.�ijw�v.••o-• (•to�,n Owner's Phone#: 2S'Z-S'fk-2:9'%S--
O, 04 v
Ageft4 Name:pelPhonem ys'1 tl9l l
Agent's Email:
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 wRh dimensions must be prov ded with this letter
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 (DC" 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 appl�ta bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
1 DO wish to waive some/all of the 15'setback ,q l
Signature of Adjacent Riparian Property Owner
OR
1 DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:A��
Typed/Printed name of ARPO: Te.me i..
h,Jaihng Address of ARPO: i ZO il`�C 2R`i`i�
ARPO's email _gvep ml r rAARPO's Phone#:
Date; _,._._. ��� 8 �� � _...__— waiver is valid for tip to one year from ARPO's Signature*
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REt�UESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: EGaik- to - H'eett,
Address of Property: / t Z 1r �a.,r.•o p eir r 1 �.�
Marling Address of Owner: (ert'fi34 , NC 2'194 4
Owner'semail: Q.mn� (. Gd Owner's Phone#: Z5 Z•" i S'"(- "19 2I
Agent's Name:
Agent's Email:
Agent
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 forthis
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 wfth this letter.
1 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 (DCIM in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin Sf., 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, of
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 tiptop 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
Si4hature of Adjacent Riparian Property Owner
-OR-
1 DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO; s ` a W , to-t.ea. JL
Mailing Address of ARPO: t a� _Ca fort, v 1-11 . wet��°r °`— f ��
ARPO's email• WrAdoQ y+ytwwvr.a IARPO'S Phone#:
corn,
Date; 2 Z9 ZY ®'waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

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