87070A - Swimme, Mark & Teresa (MOD)

`°`tour' D.CAMA ❑ DREDGE & FILL Nn 87070
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. 0 General Permit Rules available at the following link: wwsv.deq.nc.gov/CAMArules
Applicant Name
City
Phone # ( )
Email
t:
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length —�
Is .xti
Pier (dock) length 6Da?1.i+ i
Fixed Platform(s)it C 1 t- «•. Mo a ti,ys. F mow•^
If
Floating Platform(s)
I I
Finger piers)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore _
Breakwater/Sill
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp
Beach
Other
SAV observed: yes no I -- j
Moratorium: n/a yes no
Site Photos: yes no „' 1
Riparian Waiver Attached:
A building permit/zoning permit may be required by: WC ter
i
Permit Conditions
(Scale: )
❑ 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 PROJECr 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** Signature
i
Application Feels)
Check #/Money Order Issuing Date
Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiF1CATIONMAIVER FORM
CFRTtFlEO NIA R T R� N RECCIP RE TF
acp portion to be completed by owner or their agent) RECEIVED
Rune of Preq eaty Cb++risr: t�"FW"C,c a 't 11
Address of P,openy: i¢ s (' &e ca R,•... a fil-+rt; r.� h _ 7 `� V
OCT 3 1 2023
sc.`,�G' �n► /Aj
Owncv'sonu,tityny,y 34,i .•nk-ft tSwneisPh,)ne i 3}2j . ;1i`t, Dls/� lVl-E
A oi'ra Nnron' `t,,,,; - AijorO.
A' aai'a Et:lal .R:'*•—�[`N ^s .. � .+at: � •ae +t_
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
t nom portion to be comi&fed by the Atltacettl Proogrj�,Qytg ;
I "iotyy mitify that I owWeMty aulaccrii w the ukove-uIc,an cW propany. The indKkival np0yirQ `or lh s
Pamli: haS acac•ibect (0 me, os sTiown or Joe aQadhod crthvistg. the dovetopnent they are prosa;IrtCI. to
dosG� ti,p rr .waif te+tM �^�:`a,i b!t Xx4?Y 11 wi'l}-lAk;ttur.
"�' I I>O NOT tiuve objections to:tts protxisai. 100 F,ave objectkms to Rik o•ciposai,
n youyour have abeceons in what is'keing propasad, you moat not tba :C. AWtsion of Cr s(at
Allanag irnaat (f)CM) In writing within TO days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 306, Elizabeth City, NC, 27909. t2CM representatives can also be
contacted at [phone], No response Js considered the same as no objection If you have been
acifified by Certified Abaft.
WAIVER SECTION (Chou" on o
1(awf irs' mri that nny pnrAY.Ked fief, dock, moe,-ing pyry0s. btrA romp, p, tyc a vaha, tx)auyomn, hit t or
groh nX):5t tyn cot back a rrdnimum d'sstar :e a#. IS* ror) my vcxr at riparlon ooct*i; unfeus wuived by Ina
('alit ena-e mi AN* In tratkgods tx'rtR emrnaMsi. (if yo¢, wish to wakn ;hey sr.'hxx, yMnr emrst R n
t AR Appoopt.9ta t"WI* helm'.)
I DO w sh Iowa ve somotoll of ,he tb' saWkK*
Signvrteo :;' Adjacent Riparic:s Omper(p 0xniar
.Op.
I ISO NOT wish low,0M',h,a LS' scNbaak •�riatrrent (nittat th:� htnokj `!,�-.��?,. -
i
Signature of Adjacent Riparian Property Owner
TypoolPrtntod name of ARPO:
Mailing Address ofARPO: Lilt . 'Z'rj.:-ic� C t j' -5'K7 ff, 'L:,t.. C %,i4
ARPO's email,
Date; L942 ,,, „_„__"waiver is valid for up to one year from ARPO's Signature`
RevisodAugust 2022

i
N.C. DIVISION OF COASTAL MANAGEMENT RECEIVE
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAiVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY OCT 3 12023
(Top portion to be completed by owner or their agent) �fl►/��
EG
Name of Property Owner: MA✓ctc a \tk (2aS/a S tAwvrl� ®C "_
Address of Property: 10 S L2,Cg`) ,v C- r t�-1441_A lvC :1-7 44 _
Mailing Address of Owner: `14 NC P790 I
Owner's amali; }�Ml1S_., wl MLHKA ion' f5wner's Phonelk ? .2 336 164*i 3
Agent's Name: /JWfL r St oim Ott Agent Phone#; 2 z. .UA 1944 ?�
Agent's Email: ✓Vkea� w mMC tr.eY nU, . do
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacenl Property Owner)
I hereby certify that I own property adjacent to the above referenced property, The Individual applying for [his
permit has described to me, as shown on the attached drawing, the development they are proposing. A
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 (L)CM) In writing within 10 days of receipt of this notice. Correspondence should he
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted of [phone]. No response Is considered the same as no objection If you have been
nollfled 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 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 16' setback
Signature of Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 16' setback requirement (Initial the blank) i
Signature of Adjacent Riparian Property Owner;
TypedlPrhtted name of ARPO:
Mailing Address of ARPO: ' '� ` v)%- iS /V > C t
(l '� L �� ARPO" s Phone#:
ARPO s email:`. X) a — iG
Date: r ? *waiver Is valid for up to one year from ARPO's Signature*
Revised August 2022

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION & WAIVER FORMS
GAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners (15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign -off by the owner on this form) or carliged mail return
receipts (showing delivery of notice) are needed.
The purpose of this notice Is to make adjacent riparian property'oviners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to) the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permiaslon" of adjacent property owners Is not necessarily reoulMd for DCM to Issue a permit; however,
permission must be obtained for cortaln types of proposed devolopmentsif they fail within a 15'setback area
along the riparian access area of the adjacent property; as determined solely by DOM. It Is In the applicant's
best interest to provide comprehensive and accurate notice so'that any concerns or objections can be
resolved early In the permit review process. In addition, If the adjacent riparian property owner appeals the
permit decision, Insufficient notice could be a basis for granting such anappeal.
Who Is an Adjacent Riparian Property Owner?
What Is Adjacent? (Note: DCM reads this broadly to ensure comment W. potenlMly impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
• A properly that fronts a natural or manmade waterbody that Is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
Easement holders? Yos, if the easement could be Impacted by the proposed development.
• Sheets/Roads? Only If the strootfroad could be impacted by the proposed development. This
might include street -ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What Is Riparian?
Do the boundaries of the adjacent property legally Intersect with the water at mean high tide? If there Is a
question about whether an adjacent properly Is considered "riparian; please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or In the water.
WhoNVhat is a Property Owner?
For private Individuals (or families), send notice to the address listed on the tax card. If the property Is owned
by an Inc, or LLC, please send notice to the person listed as the registered agent on the NO Secretary of
State's Corporations Look Up site: 110D vrvw sosnc.gov/search/Indeslsora. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do i ensure It is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return It to DCM; OR
• You can hand -deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
You can mall this form by USPS Certified Mall, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mall package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DOM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised August 2022

RECEIVED
OCT 3 3 2023
DCM-EC
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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; MA✓Ctc d { }�VCaS� S rNy✓r�
Address of Properly; toS- Coro\ N 0- A-y 41,-A .NG .1r7g4�1
Mailing Address of Owner: 1 g`i I .o..n-u s t..N Cl NC- a79d �
Owner's email:4t-A/t5n (e swig m A IpA' 60Wner's Phone#; 3 3 e V44 3
Agent's Name: jMda-k .5lNinnnlc Agent Phone#: YS z _tea {N
Agent'sEmall: S/Vlar}`i'rd 3w:rnMGO.eY 5" . * n/%
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that 1 own properly 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.
q you nave objections to what is being proposes, you must notify the N.G. Division or coastal
Management (DCM) /it writing whirin 10 days of receipt of this notice, Correspondence should he
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909, DCM representatives can also he
confacted at f252) 264-3001. 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 1 T 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 sometall of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive Iho 1W setback requirement (Initial the blank)
Signature of Adjacent Riparian Prygerty Owner;
Typed/Printed name of ARPO: % ` a �>�Kri V ll t . U' O r� +e
Mailing Addresls__of AR1PO;1,3 l '�• LYr.J C, - + tWb r 4c
ARPO's email: Y)q YJ Sf' �� C kJ-rA PR O's honeff: _11<-\ - `f a I — I D2L L IAVf
Date: Iy *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 NOTIFICATION/WAIVER FORM
CERTIFIED MAIL, RETURN RECEIPT EQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: ( A'I'm a tv4uKaS/a Swt ww�
Address of Property: 10s Cerg\k� cll 4 writ 1JC- X7,J4'-J
Mailing Address of Owner: � $1{ Luau-1 t r' tf f t 't etu4-1 G NG a790 `j
Owner's email:4k,%tvt5s P S14 r,a g:n' Owner's Phone#: -257A � �3e Vi4 3
Agent's Name: a/Zk_ S1-A,,4tc Agent Phone#: YV.z
Agent's Email JVkr)�ir N S w v„v+G a. son , n n
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
desertMon or drawing, with dimensions must be provided with this letter.
A I DO NOT have objections to this proposal. I DO have objections to this proposal.
IT you nave pbfecttons to what 1s 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 (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' rrom my area of riparian access unless waived by me
this does not appiv to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
100 wish to waive some/all of the 15' set
Signature of Adjacent Riparian Property Owner
•OR -
I DO NOT wish to waive the 15' sotback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
Mailing Address of ARPO: 03 STty *cy_ j (✓ `//k
ARPO's email' fG v�5ey�`bt3 tt .�, �PO's Phone#: ` 'S-7 6T,:3 - (n7Z� �j2j�Z
Date**waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

ta"`rv, XCAMA ❑ DREDGE & FILL Ni? A7070 (3) e C D
a permit
GENERAL PERMIT Date us previous ousp
Date 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 1M`(2oo ❑ Rules attached, 0 General Permit Rules available at the following link: w.vw.degnc.gov/CAMArules
Applicant
City Elilak,% e��4 State (�Q ZIP '7t%�IVtY
Phone #11� i (&W -I'M
Email TCiV' nqv eswtrhny'- o"KAwil clam
Authorized Agent
Project Location (County): 7a r- ,S
Street Address/State Roadd/Lot#(a) 1l0 '# C-6,211
105 Ccif-duN cf.
Subdivision A 16-,A� IQ i?lctn44ft-dy%
City (12 r46Y'G ZIP 2%g'/y
Affected ❑cW ❑Ew g]PTA ❑ES ❑PTS Adj. Win Body Ye0a1fA •(_.rV ( at/ an/unk)
//�� II i
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Win Body P16.0-1\ C(e_ SOtlsCA
ORW:yes fio PNNAi yenhb
Type of Pr//o)j��ect/ Activity 0ZI''N kyu k- fa. C r � S f K (o R(2,r W/ uLt P r.c:i 2b` k 7L1/
�tt"or a1V+ (Scale: 1
Shoreline Length IOi
Access length r'
Pier (dock) length
fixed Platform(s)
Floating Platform(s)
Finger pier(s) 1
I
Total Platform area L liUS•�
Grain length/9
eulkhead/ Riprap length r�
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin, channel 1
Cubic yards Boat ramp
Boathouse/Boatllft
Beach Bulldozing I
Other
SAV observed: ��ec
yes
Moratorium: nO
no
E
Site Photos:
Riparian WalverAttached:
�yes�
�YSs
no
}'.
yes �"Di
A building permit/zoning permit may be required by:
1Z ,V"t) EA„C ock'L
C
Permit CondlBans
L
TARIPAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
_ �\/ � v v v- -&W fA L M/r
Signature *'Please read compliance statement on back of permit• Signature
,Vaeo ,ass N q 123 `11'112 y
Appllcadon Feels) Check g/Money Order Issuing Dale Expiration Date

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