87083A - Bray View Landing POA

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❑CAMA ❑ DREDGE & FILL NI?87083 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑ 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 I ❑ Rules attached. ❑ General Permit Rules available at the following link:wm-vdegncgov/CAMArules
Applicant Name
Authorized Agent �—ir.:. . �I,— ,,,c . ;,, :it
Address
Project Location (County): ' O (t - I 'f -.! •. (.
City
State
ZIP
Street Address/State Road/Lot #(s) i
Phone # ( )
Email
. ,_
, >
'rvt
Subdivision
City ti J ,._ 1- ZIP
Affected ❑ CW
❑ EW ❑ PTA
❑ ES ❑ PTS
Adj. Wtr. Body V (l : L Ci. •.; (naVman/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW
❑ SPIMA ❑ PWS
Closest Maj. Wtr. Body f- i J t r S \ a , !''-
ORW: yes/no
PNA: yes/no
Type of Project/ Activity
(Scale:I
Chnrnlinn I nnafh
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on
Finger pler(s)
Total Platform area
Groin length/#
Avg distance offsho
Brealkwater/Silll
Max distance/ length
channell
Boathouse/ Boatlift■■■
Beach Bulldozing
Other or
mom
No
Elm
it
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IN
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■■■■■■Basin,
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"r-MIN■MEMNI■■■■0
No
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MIN
NMI
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no -1
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0481111
NOME
MOM
A building permit/zoning permit may be required by: TS k ,) C_7 i_i Yl A a;
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)_
1 7
I
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit'• Signature
Application Feels) Check N/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit. 3(-ay L);CLO LCxyt�.'ncFDA
Mailing Address.
Phone Number:
Email Address:
certify that I have authorized
IM r,iaE"Cr`7 Dr, NloyocK,,UC 2-71159
(-?a7) G35-51179
A ✓lri 5 Pe✓1r y -PoA - i%vr�
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 'Re Place- Ex(54iAg Rer w; it`l A CW
kki Skr,x�oo +obi 12-'tnan e-K;s-ling CkV4 Ater- Viers.
at my property located at 13V7r, MoyocK, AX Z79 5 ff
in 6>(r%TVLK County.
I 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 Information:
Signature
G' 615 tfleNr'/
Print or Type Name
-?0 f} �2fe5,'den 4
Title
I/ 1 $ 10OZ3
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completedbyowner or their agent)
Nameof Property Owner 3foy V;Cvo Lartp�✓<Gv hOfj
Address of Property: 13 8 W atcrs 'D e— M o)t oc k , /,)C- Z 7g1519
Mailing Address of Owner. 117 -�)f , Moyoc K e A)C 2 79 5 8
Owners email,
,'41oall [e-mail]'s Phone#: (757� C.36 -5971
Agent's Name: Ci�lrr5 Htrlr� (-Pod-Pre s) Agent Phone#. (7,17� 635-5979
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, with dimensions, must be provided with this letter. ty <
¢4 `O
I' DO NOT have objections to this proposal. 1 DO have objections to this proposal. .� 9)' L
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal �Ip
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be 3 11512+
mailfed 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 rioran revetments). (If you wish to waive the setback, you must sign S
the appropriate blank below.)' 'J
I DO wish to waive some/all of the 15' setback 5 ter- �/ 41
Signature of Adjacent Rrpanan Properly Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank) V
3
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: (�yJ j L L I P) Nt A 96 k j
Mailing Address of ARPO: / `)L A Lb N L, lv% A U\-f G & I<
ARPO's email: ARPO's Phone#: 2 f 2- t 7 S 3 3 o f
Date: '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 NOTIFICATIONMAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: 'BrApt vY �� C W Lc�✓vrn(�
Address of Properly: 13`a W«i-crS Dr. Moyoc A)C , 2715 ii
Mailing Address of Owner: 117 ln)^i et Dr Mo oc K NG 2 79 5 8
Owners email: D;r4b Ak (0456401. eP' lOwner's Phone#: C757� G35- 5971
Agent's Name: clnrr5 Ne+nry (POs Pres) Agent Phone#: (.?57) G35' 39 71
Agent's Email: ,'v-4 ba)1 (,ct56 901, cc)m
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that I own property adjacent to the above referenced properly. 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. otviston or 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 riprap revetments). (If you wish to waive the setback, you must si n
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:
Typed/Printed name of ARPO:
Mailing Address of ARPO: % ir/� �' 1 ✓� l� �'i)Ct/;t%, , I (%C 17%Sk
ARPO's email: ku I�Lx Gc�l l'. t/Ls�i?crl,rkblRPO's Phone#: 1fS%
Date: /q'i'i r1 X' 2 > 'waiver is valid for up to one year from ARPO's Signature"
Revised August 2022