87221A - Hall, David

N9 87221
Previous permit
A B C D
°``°"" ❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
3 Date previous permit issued
❑New ❑Modification ❑ Complete Reissue ❑ Partial Reissue V'
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 ❑ Rules attached. General Permit Rules available at the following link: www.deq.nc.eov/CAMArules
Applicant Name
Address i
City
Phone # (
Email
ZIP
Project Location (County):
Street Address/State Road/Lot #(s)
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nar/manjunk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity -4 k. `"
(Scale:
Shoreline Length
Access Length
—,--i—
—
-
-
.—'
i
—
—
-
Pier (dock) length
Fixed Platform(s)
-
-
_
Floating Platform(s)
G
Finger piers)
-
I
Total Platform area
r
E:_:>
I
Groin length/N
Bulkhead/ Riprap length
Avg distance offshore
-
--'�
-
--
Breakwater/Sill
Max distance/length
-'
Basin;;ch lOQ
--
_ _
_
—
Cubicyards y
F
Boat ramp
Boathouse/Boatlift
-
-
L�.._.
I
y
Beach Bulldozing4
Other
IV
-
e
-
-
--
�'
t
SAV observed es noMor
�!�� yes r
Ta
y
'
iJ
r
(-
Site Photos: i_ye;i �
yes
I
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Riparian' Waiver Attached: ` no
�'"";?'y
+
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A building permit/zoning permit may be required by: t- L. C a r I t 1
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
i Ra-,
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statemenli on back of permit*
*
/ Signature
Application Feels) Check R/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: nod iA 4,,((
Mailing Address: a8; R�S 6 r— ekuo Re(r
ny-6 r�d� z►gzl
Phone Number:
Email Address:
I certify that I have authorized L Yoz`O.A COA" I Kelli Thompson
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 227 8 Au., �f%sv�%Z�t. C°�°IiG >7e enn Z�
in L.�/Ir{vdt County.
I furthermore certify that 1 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
Information:
Signature
�4 X r
Print or Type Name
Title
Date
This certification is valid through —L2—1 3_ � J 2 y

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Dnoij ActO
Address of Property: Z'LS-6 6 c-za't ` '0e '
Mailing Address of Owner. aA, 4�1i�t t C Y a �d j / YTt2.t `t L/
Owners email: P,,,r xta 5 1,01 d iodK�,odd Owner's Phonefi 1I13 ••'A %— 6 f ro 3
Agerrt's Name: A40M Phone#:
Agags Entail:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bgftom Portion )iq be comglgo by the Ad(acent Property Owrrerl
I hereby certify that I own property adjacent to the above referenced property. The individual applying torthis
permit has described to me, as sham on the attached drawing, the development they are proposing. A
description ordrawino. with dimensions must be provided with this letter.
I DO NOT have objethWn8 to this proposal. _ 1 DO have Objections to this proposal.
it YOU love objections to what to berrrg propose% you must nouly the Nx. ONisam or uossrar
Management (DCAQ in wrltMg within 10 days of receipt of this nottom Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 2"3901. No response /s considered the same as no objection If you have been
rodifad 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 Sian
the appropriate blank below.)
I DO wish to waive sonWall of the 15' setback
Signature of AcVacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)t3-
X Signature of Adjacent Riparian Property Owner:
TypediPrtnted name of ARPO: Rod T �t� O lr g ✓
Mailing Address of ARPO: CC t -7 in,r'^ r f� Guyt act .
�! ARPO's email• rA tk2QL$ Ocb X,iC&O kftPO'S Phone#:
,Y Data: 11 - ( " - 4> 'walver is valid for up to one year from ARPO's Signature'
Revised July 2021

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