87279A - Nash, Thomas and Lynn

3��`°"'" ❑CAMA ❑DREDGE & FILL N9 87279 A B C D
3 GENERAL PERMIT Date Previouspermit
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. .nc. v es
Applicant Name -
Address
City i. State ZIP
Phone # ( )
Email
Affected ❑ CW ❑ EW ❑ PTA ❑ ES K❑ PTs
AEC(s): ❑OEA ❑NA ❑UW SPIMA ❑PWS
ORW:yes/no PNA: yes/no
Type of Project/ Activity
O...mne Iunmh
Authorized Agent i
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City I
Adj. Wtr. Body : (dat/man/unk)
Closest Mal. Win Body
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Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore x distance/ length Breakwater/Sill�■H
Basin, channel
Othermom
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SAV
Site Photos: yes no
Riparian Waiver Attached: yes nod.
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A building permit/zoning permit may be required by:(110
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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 q/Money Order Issuing Date
Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWA1VER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner.
MAR 1 9 2024
&,J!'IVE-EC
/VC a ?goy
Al(f a7iby
owners email: � J r"Owner's Phone#: [phone] -Vff �
r
Agent's Name: !#V / e Agent Phone#: WU -
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacenfi Property Ownec)
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
—*/— I DO NOT have objections to this proposal_ I DO have objections to this proposal.
it you have objections to vvirat is being proposed, you must notify the N.C. Division of Coastal
Management (DCMJ in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Grfffin St, Ste. 300, Elizabeth City, AIC, 27909. DCPdr representatives can also be
contacted at (252) 26-�r 3901. Piro response is considered the same as no objection if you have been
notified by Certified Mail.
WARIER 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 %vish to waive the setback, you must sign
the appropriate blank below_)
I DO wish to waive some/all of the 16 setbau< � -A
Signature of Adjacent Ripada. Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian P
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: Iq
Date:
Owner.
ARPO's
*waiver is valid for up to one year from ARPO's Signature=
Revised July 2021

RED"'� �
N.C. DIVISION OF COASTAL MANAGEMENT
MAR 1 9 2024
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY D i\A . t (
(Top portion to be completed by owner or their agent)
Name of Property owner. fK0iI(4&5 V / Ylr,./1/ ✓ �✓ �/ ,1/' f, /A►/
Address of Property: !�� /N O��ON LO�%� ��/Z/i (�C/[ ( /•n/' `• �� • r" r
Mailing Address of Owner:
//7 /yind�TO/✓ �00� i%C9�f Ci AlC �9`tdg
e o/tf
Owner's email: f/0i�lhi/ �li MW Owner's Phone#: 4;5a?- al`i0�-108 T-
Agent's Name: LH r, Agent Phone: 41404G F/3
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.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
it you have objections to o-vhat is &wing proposed, you must notify the 1V.C. Division of Coastal
Management (DCIV1J in wriii119 witifin 10 days al 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 of (252) 2&-3902. No response is considered the same as no objection ff you have been
notified 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 sign
the appropriate blank below.)
g r n/C
I DO wish to waive some/all of the 15' setba
Sign ure A -cent/Rr arian Pro'r�a gwner
_OR_ Aic r,, /Yi4�� i �/teslG�eN
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: .,f
Typed/Printed name of ARPO:Mom F //r Mailing Address ofARPO:
ARPO's email: ° RPO's Phone# :
Date: _'waiver is valid for up to one year from ARPO's Signature
Revised July 2021

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RECEIVED
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