87216A - Kieta, Edward and Fern

��'`e"r", EUCAMA ❑ DREDGE & FILL N9 87216 A B C D
aPrevious 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: www.deq.nc.gov/CAMArules
Applicant Name ' f t V Authorized Agent
Address :� �. ` i Project Location (County):
City State ZIP "I Street Address/State Road/Lot #(s)
Phone #—
Email
Subdivision
City
Affected ❑ cW EW PTA ❑ ES ❑ PTS Adj. Wtr. Body (nar/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/Po - PNA: yes/no
Type of Project/ Activity
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A building permit/zoning permit may be required
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)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature**Please read compliance statement on back of permit**
Application Feels) Check N/Money Order
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Edward Kieta
Mailing Address:
Phone Number:
614 Surfside Dr Edenton NC 27932
951 7220190
or' EdK%t� ° 6tenail.(Ov(v\
Email Address: [e-mail]
I certify that I have authorized Travis Lilly (Lilly and Son Construction
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Pier
at my property located at 614 Surfside Dr Edenton NC 27932
in Chowan County.
1 furthermore certify that I am authorized to grant, and do in fact 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 I ormatio
Signature
Ed Kieta
Owner
Print or Type Name
Title
11 11 /2023
Date
This certification is valid through 3 / 31 / 2023

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: ^L� C' d" , f� ]
Address of Property: C9 LI , Oer;5idPll�✓� 1�
Mailing Address of Owner: G (�� Jy/T`5� le b f. Y h ic7.t /fit^_ 2% 9 3�2,
Owner's email: EIki 44�0_ (Mr`lar1 - C d"r'bwner's Phone#: 951 7),.2
- Q Q 6
Agent's Name:
Agent's Email:
Agent Phone#:
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 with dimensions must be provided with this letter.
VI 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 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.)
I DO wish to waive some/all of the 15' setback y%
Signature off Adjacent ftrpanan vroperry uwner
-OR- /Y) w d/L
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: /e I (' H1V_a
Mailing Address of ARPO: 6 /% 8cA4F5 !�'lJ!LW ron_ /V C,
ARPO's email: 4/cN/rli,vi/G.N(!Clne4Sr .NtI ARPO's Phone#: 30-5.26 9J.X
Date: J'3 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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: L-y) , n Q io hex w V, l G dl l: 'TA
Address of Property: S / 0(= Du2, �� h.7 t) /✓
Mailing Address of Owner: t"s / 9 SCtR rsio c Jivz• eocNTnOA1
Owner's email: C_ � /1 lc%/� O CV)s Wa edbwner's Phone#: 7 -/`
Agent's Name: N�? Agent Phone#:
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 forthis
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 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.)
I DO wish to waive some/all of the 15' setback l� , , _ b . /t� , _ _ ,
SignaturreWoffAddjj /entt Ripfalriaan(Property Owner
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: jiyoy:c rJ / rta-tA�,r✓
u p
Typed/Printed name of ARPO: -N-i I n
Mailing Address ofARPO: JIAfTSIGit r ZiieV6n 40, 2',9-aI
ARPO's email:YNpYGMIhnOfAAu- II l y P_�ao 38a�O2aR
Date-4-4. *waiver is valid for up to one year from ARPO's Signature*
ID-a3- �,D m ` L" 0 /3 1 Revised May2021