87242A - Jackson, Kos and Cynthia

+*scow"' ❑CAMA El DREDGE & FILL No 87242 A B C D
Previous permit
f S GENERAL PERMIT Date previous permit issued
M 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 Authorized Agent
Address Project Location (County):
City State ZIP I' `, Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body �� :' I .-: z 1... - (n4t/nr unit)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body -
ORW: yes/no PNA: yes/no
Type of Project/ Activity -
(Scale: )
Shoreline length
Access Length
Pier (dock) length
't
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-
!
f>_r
,t•
--
'
T-
-(
Fixed Platforms
�—
5—mot
r'-
Floating Platforms)
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_.' c
c
•r,
-
I,�.
_
r-
r1�—
—I
-
Finger pier(s)
L'.
1
n
`i
Total Platform area
_
_
Groin length/#
77
Bulkhead/ Riprap length
Avg distance offshore
-
-
-
Breakwater/Sill
Max distance/length
-'-
—I
—
_
--
---
--"--
,--
-
--
—
j
•E'.
Basin,channel.'
Cubic yardsf-
Boat ramp
,_
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j
Boathouse/ Boatlift
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atdfo
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j
Beach Bulldozingnz
Other
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n
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)
..y
I
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-
-
SAV observed: yes
-
-
!
Moratorium n/a- yes no
7
-
I
-
Site Photos: yes no
( �
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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
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" Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
Date
IA/ I , f 14 fir Hoi.r
Name of Adjacent Property Owner
110 LHkUC H t,A>JOIr/G fit?
Address
%t'I0yaC IL No E3
City, State Zip
To Whom It May Concern:
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit
to r3l.(LKW An U R1I� 1�AP
on my property at 6 6 a. C D V E K D E E LF2 fZ D i 1v C, a2 C! f in
County, which is adjacent to your property. A copy of the application and project
mowing is atta&ed/Qnclosed:for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to
me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be
considered that you have no comments or objections regarding this project. If you have any questions about the
project, please do not hesitate to contact me at my address/number listed below.
If you have objections or concerns about the project, please mark the appropriate statement below and send your
correspondence to the NC Division of Coastal Management (DCM) at 401 S. Griffin St., Ste 300, Elizabeth
City, NC 27909. The staff at DCM can be reached at 252-264-3901.
jl0 5 JA CK567A/
Property Owner's Name
E AD
I have no objectic
I have objection(s
Adjacent Riparian Signatu
Print or Type Name / Date
Sincerely,
a52 � 6 ' -al R7
Telephone Number
■ ComiAete items 1, 2, and 3.
■ Pririt your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addlessed jo: � r
7q V
11
cmmu...
A. Signature
X
I d by /prints ame) I
6 TL
D. Is delivery address different from Item
If YES, enter delivery address below.
❑ Agent
❑ No
III IIII'II'III'I�I'III IIIIIIIIII II IIIIIIII IIII 3. Service Type ❑ Priority red ExPressO
MslTM
❑Adult Signature ❑ Registered Mail*"'
rCSS ❑ Adult Signature Restricted Delivery ❑ Registered Mall Restricted;
❑ Certified Mall® De g2nary I
9590 9402 8640 3244 9675 00 ❑ Certified Man Restricted Delivery ❑Signature Conti ma ion*• I
t C rrmatton
❑ Collect on Delivery q S�gna nature
on
2. Article Number (Transfer from service fahen n r'^"` ^n Delivery Restricted Delivery Restricted Delivery
A it
7020 2450 0001 0854 1868 nail Restricted Delivery
I tover ffi5001
PS Form 3811, July 2020 PSN 7530-02•OOR•9053 Domestic Return Receipt

CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED
J-4
Date
alE Qaa&eT 5
Name of Adjacent Property Owner
573 1 �riy c R D
Address
y-
City, State Zip
To Whom It May Concern:
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit
to 61AKE A uul y >JF 2CA WEAP) OF Sio�Ic" TO 1?Rcyk1J1 1"U OT14F'R
Ep-ri "bSt'rt�ali �b ilt,yt RD_ 1JFKT-FbA NC ��� a in
on y pr p p 3 �
?E12 Q uk) 0 h hl S County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to
me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be
considered that you have no comments or objections regarding this project. If you have any questions about the
project, please do not hesitate to contact me at my address/number listed below.
If you have objections or concerns about the project, please mark the appropriate statement below and send your
correspondence to the NC Division of Coastal Management (DCM) at 401 S. Griffin St., Ste 300, Elizabeth
City, NC 27909. The staff at DCM can be reached at 252-264-3901.
Sincerely,
Property O s ame
2549, -Z-y I
Telephone Number
I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
Ave
�({; Z333 Z,620
Adjacent Ripan Stign pre Telephone Number
Print or Type Name / Date Email Address
Address city Ntate Zip

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C�dU�� I �.
lot
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Cave
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Locality
Permit Number
Ocean Hazard Estuarine Shoreline ORW Shoreline _
(For official use only)
GENERAL INFORMATION
LAND OWNER - MAILING ADDRESS
Name 45Q5 n1YniC ]E) S 0 N
Address h& ` 0 V L= JR D
Public Trust Shoreline Other
City 11 )� fZ� T F 0 State f J C Zip A79 4 4 Phone
Email k 0 S C y n
AUTHORIZED AGENT
Name 1 t+;JT> 0i,v Ne R A13oV.
Address
City
Email
State
Zip Phone
)5�-A64 -Z `5n
LOCATION OF PROJECT: (Address, street name and/or directions to site; name of the adjacent waterbody.)
2
0.�'9,/VG i Fr
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) b Lt Iti K 14 E'A i7
!lSINU' ?)I?�AP(slt � Fivice)) AcA/N5T--wgr L)yL A� tTrx1STS
SIZE OF LOT/PARCEL:
square feet )_ 9LU S acres
PROPOSED USE: Residential ❑ (Single-family [I Multi -family ❑ ) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer ifyou are not sure which AEC applies
to your property):
NO `('U -D E k i5T5 ON -1-I115 $ i DL
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: square feet (includes the area of the foundation of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State
Stormwater Management Permit issued by the NC Division of Energy, Mineral and Land Resources (DEMLR)?
YES NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
l t
Van owner or record title, Title is vested in name of K& S L y N T li J A C- < 5 0 N
see Deed Book q 113 page 5 ie �4 in the R (Q a 1 NL R t%/ SCounty Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
; probate was in
County.
if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(1)
(2)
(3)
(4)
(Name) (Address)
311.t -1 '� 7DE136 )E RJ>O 5 Cove;.
WILL6E 6, 1'IOLT 110 LAU*/CH LANIJ]N'G n>!o"c 1ilr 2-:2q
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
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.
This the V day of _> 20 All
Landowner or verson, thorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a check for $100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.

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�'Yry End
1312
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a SITE
Site Map
REVIEW OFFICER CERTIFICATE
STATE OF NORTH CAROLINA
COUNTY OF PERQUIMANS
I, , REVIEW OFFICER OF
PERQUIMANS COUNTY, CERTIFY THAT THE MAP OR PLAT TO
WHICH THIS CERTIFICATION IS AFFIXED MEETS ALL STATUTORY
REQUIREMENTS FOR RECORDING.
REVIEW OFFICER DATE
STATE OF NORTH CAROLINA - CHOWAN COUNTY
I, MARK D. PRUDEN, CERTIFY THAT THIS MAP WAS DRAWN BY ME OR
UNDER MY SUPERVISION FROM AN ACTUAL SURVEY BY ME OR UNDER
MY SUPERVISION DEED
/DESCRIPTON�RECORDED IN DEED BOOK
4737 E PAGBOOK —/
PAGEC6 %6 PLAT CABINET SLIDE
THAT THE ERROR OF CLOSURE AS CALCULATED BY LATITUDES AND
DEPARTURES IS t: 1491z-_Irle-�
THAT THE BOUNDARIES NOT SURVEYED ARE SHOWN AS BROKEN
LINES PLOTTED FROM INFORMATION FOUND IN DEED BOOK ":? 7/
PAGEMAP BOOK —PAGE— PLAT CABINET —
SLIDE -THAT THIS MAP WAS PREPARED IN ACCORDANCE WITH G.S. 47-30 AS
AMENDED. WITNESS MY HAND AND SEAL THIS
DAYOF Z �l
L-3065
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ans
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MINIMUM BUILDING
/
SET BACK REQUIREMENTS
FRONT =25'
REAR = 40'
SIDES = 15'
P
b
P
/ W
N
IN
N
LEGEND
IRS = IRON ROD SET
EIP = EXISTING IRON PIPE
(C) = CONTROL
CERTIFICATE OF OWNERSHIP AND DEDICATION
I (WE) HEREBY CERTIFY THAT I AM (WE ARE) THE OWNER(S) OF
THE PROPERTY HOWN AND DESCRIBED HEREON AND THAT I (WE)
HEREBY ADOPT THIS PLAN OF SUBDIVISION WITH MY (OUR) FREE
CONSENT, ESTABLISH THE MINIMUM BUILDING LINES, AND
DEDICATE ALL STREETS, ALLEYS, WALKS, PARKS, AND OTHER
OPEN SPACES TO PUBLIC OR PRIVATE USE AS NOTED. FURTHER,
I (WE) CERTIFY THAT THE LAND AS SHOWN HEREON IS WITHIN
THE SUBDIVISION REGULATIONS JURISDICTION OF THE COUNTY
COMMISSIONERS OF CHOWAN COUNTY.
Date
i Date
I CERTIFY THAT THE SUBDIVISION PLAT SHOWN HEREON HAS BEEN FOUND TO COMPLY
WITH THE SUBDIVISION REGULATIONS OF THE PERQUIMANS COUNTY.
PERQUIMANS COUNTY SUBDIVISION REVIEW OFFICER
Owner
UNDERGROUND UTILITIES, IF ANY, WERE NOT LOCATED BY
THIS SURVEY, FURTHER EVALUATION MAY BE REQUIRED.
THIS SURVEY IS SUBJECT TO ANY FACTS THAT MAY BE
DISCLOSED BY A FULL AND ACCURATE TITLE SEARCH.
Certificate of Approval of Sewage System
This subdivision, entitled , has been designed fb
the construction of Individual sewage systems and meets the criteria and requirements of the
Pasquotank, Perquimans, Camden, and Chowan Counties District Health Department based on
existing conditions and regulations. The District Health Department reserves the right to requin
additional improvements to these properties and to limit the number of bedrooms and size of
structure based on site conditions upon issuance of the final site improvements permits. This
certification does not constitute a warranty and is issued based on this subdivision being servi
by Water System.
(Individual/Public)
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Survey For
Kos Jackson & Cynthia Jackson
Cove Road
New Hope Township, Perquimans County
North Carolina
Reference: Deed Book 473, Page 564; Deed Book 95, Page 676
Scale 1 Inch = 50 Feet June 20, 2018
50' 0. 5o, 100, ISO,
Albemarle Land Surveying Inc. C-3972
Mark D. Pruden, PLS L-3065
146 Oak Grove Road, Edenton, NC 27932
This Survey Creates A Subdivision In A County Or Town Regulated By A Subdivision Ordinance.
Cove Road \
\ 60' R/W
a• °.
N 49 °34'10" E N 49°34'10" E nra'i
9.99 --N 49 90' S 79-32-41" W
—11.32'
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Jackson n DO. 271, PG. 666
DO. 479, PG. 217
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