87246A - Hale, John

° °"" ❑CAMA[ DREDGE & FILL N9 87246 A B C D
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:
15A NCAC ❑ Rules attached. }/ General Permit Rules available at the following link: www.deq nc gov/CAMArules
Applicant Name
Address
City State
Phone # ( )
Email
Authorized Agent (: '-t, . " ( -, ; ) \ 'J , - :4;t -
Project Location (County): n 1 k.
Street Address/State Road/Lot #(s) I 1 . 1'.c. I,) r , i,r
Subdivision F� Ii\
City I _ (' , T _ ZIP .,A ! `,
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body 1.0 M\t N.,V( I r e o,... l r(hat(rliaiihnk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body L,<,
ORW: yes/no. ' PNA: yes/tio.,I
Type of Project/ Activity ` ' ..<; �,,,; .
r, .ra.� t 1 11l' L
(Scale: Pa i.
Shoreline Length =;U C'j�
Access Length 1I
SS
�
4
'
I
L
1
Pier (dock)length--
Fixed Platforms)-
-
Floating Platform(s)
Finger pler(s)
Total Platform area
�—
Groinlength/#
l
+
Bulkhead Riprap length
LItt
h}
t
Avg distance offshore
Breakwater/Sill
J
-
)"-
I
—
;-
fi
Max distance/length
1
?-
��
-
1—
-!—
C N�
1
Basin, channel
--I —
41
I
Cubic yards
r
t
J
_
-
T
Boat ramp
+
I
!
-
-
-
-
—
--
Boathouse Boati t
—
Beach Bulldozing
Other
I
SAV observed: yes no
Moratorium: `n/a' yes no
Y"�
i
Site Photos: yes no
Riparian Waiver Attached: yes no
-:_
I,-_
_
_:.
..
1._
.._
�'a..
,_
__ 16
A building permit/zoning permit may be required by: la S i yr 11 (�
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 PROJECTAND 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 U/Money Order
Signature
Issuing Date
Date

RECEIVED
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION MAR 1 4 2024
/ �
Name of Property Owner Requesting Permit: ,% 01- ,1/ C L qL� DCM-EC
Mailing Address: 1, �c ( e Zgb�}h (_dV
Phone Number: Z�� �� V3
Email Address: J °I hies 7el• uw�
I certify that I have authorized G ti ry �V) A11 )
Age / 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 I ) U ,j� r �5
in ycSL "'Ik 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:
SSignature
Print or Type Name
Title
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT (�C'\ /E®
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FO V
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) MAR 14 2024
Name of Property Owner: �O�V\ C `(U DCM-EC
Address of Property:
Mailing Address of Owner:
Owner's email: \ L�- '\<<-- e,`s7(054L kl ulvlwwner's Phone#:
Agent's Name: Gnia ( rAxw-0 Agent Phone#:'757-5��3�af
Agent's Email: Tmo,4D 00. CD-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
(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. Grim St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted a t [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 riorap revetments) (if you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Janes ( j e-
Mailing Address of ARPO: �S /A 8 � �' X J I I ("2- Cfi / C 2-
ARPO's email: ARPO's Phone#:-5 , 2_
Date: C3 %�c�% �/% b� '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 NOTIFICATIONIWAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERECEIVED
(Top portion to be completed by owner or their agent)
1\-_1 MAR t 4 7.024
Name of Property Owner: �UNh P
Address of Property: I L4 7t kV- i�sr DCM- VE-_%
Mailing Address of Owner:
Owner'semaiL S7ar)awa'\.cAA+ Owner's Phone#:
7
Agent's Name: C)- aT r_4 nDi o W a
Agent's Email:
Agent Phone#: '757 _ D 7a — '3teg
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
1 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
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 (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 somelall of the 15' setback
Signature of Adjacent Riparian Property
MR
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: G14UUCZO—' Gy `olSeE5
Mailing Address of ARPO: I ( U r (ice bit - (!:�771y
r'norn Secs m a5
ARPO's email: r0a:�l1J17112r, r0(n ARPO's Phone#: 2s 2 - 3313320
Date: 'waiver is valid for up to one year from ARPO's Signature`
Revised August 2022

IT
RECEIVED
MAR 14 2024
DCM—E C
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ia-

RECEIVED
MAR 1 4 2024
DCM-EC
4-

RECEIVE)
MAR 1 4 2024
DCM-EC

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