87281A - Jones, Terry and Joyce

OCAMA U DREDGE & FILL N9 87281 A B C D
GENERAL PERMIT PreviDate r permit
Date previous permit issued
FFI 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 folloveing link:yvWvy.deq.nagov/CAMArules
Applicant Name
Authorized Agent
Address
Project Location (County):
City
State
ZIP
Street Address/State Road/Lot #(s)
Phone # O
1,
Email
Subdivision
City ZIP
Affected ❑ CW
❑ EW ❑ PTA
y❑., ES ❑ PTS
Adj. War. Body (nat/man/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW
❑ SPIMA ❑ PWS
Closest Maj. War. Body
ORW: yes/no
PNA: yes/no
Type of Project/ Activity
(Scale:.),;
Shnreline 1 meth
■■■
■■
H■■
EPEE
■■■■��■■
Floating Platform(s)
N�
::::■::
Finger pier(s)
IMMEM
Total Platform area
■
■
■■l�91llwl
Groin length/#
Cubic yards
Boat ramp
Beach Other.. .
:�
■ill■!�lli�l�■■■■■Ya■■■■
sm
I
8::
..
■■
■d
■■■■
:MEN
C■.■..■:.
■.�■■:■■■..■.
■E■■..■■.■■■■.■
■::�■�iei�:::::ii:■i■i:■:i:::SAV
observed: yes
ME
0
A building permit/zoning permit may be required by: (.1 ko�.,c Ito..:. �
❑ 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**
45.^,), �V .some *)WILA
Application Feels) 13 C e-s 44 �„1. /. "". „a\Che_ck N/Money Order
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Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
N
Phone Number: — 4$a 70
Email Address: I y)A&J " 4 eALJ • e0,1tit
I certify that I have authorized
Agent/
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 4�C?coa&
at my property located at
_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:
SignatutV
Print or Type Name
Tit
3 i ro 126 z&
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: a ret t ,f�,( `I66C-S
Address of Property: Iu4'
Mailing Address of Owner:
Owner's email:
4 Il Lcuse, Ue4n�,-
Q " 'COCAL
Owner's Phone#: aS Z'
Agent's Name: to-rni && i Agent Phone#:
Agent's Email: �' r 01 CD' LOK —
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
3
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
1 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.G. mvrsion or Goastat
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
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
of Adjacent Riparian Property Owner
No
I do not wish to waive the 15' setback requirement (initial the blank)
V Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: ik �l y N1i1
Mailing Address of ARPO: jod
ARPO's emailb'4 /�nt1 �e(et7U1IrUKAJ0ARPO's Phone#:
Date: IO f tj - 20, *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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 completed by owner or their agent)
Name of Property Owner:
Address of Property: 104 S Ad L Ae I c�-7BI
Mailing Address of Owner: S e_
Owner'semail.- Itywec&"w ole-(S (:' �t('LUOwner's Phone#:
C
Agent's Name:
Agent's Email: L—�'-k621�' @
cam
Agent Phone#: 203 _ 25 MOOD
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
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
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 some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
rem
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:
e
ARPO's email: IIJG'N�f 1J5 (a7�q•Cdsk ARPO's Phone#: 2' 3)3l its S
Date: to 44a d,6aJ *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

u'�, t k • �nA9'Y