87284A - Ekberg, Larry and Ririe, Jill

�,Aom MCAMA ❑ DREDGE & FILL N° 87284 A' B C D
a . GENERAL PERMIT Previous 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. Q General Permit Rules available at the following link: www.deo nc gov/CAMArules
Applicant Name
Address 1 '.
City
Phone # I—)
Email
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State F-) (. zip ,a `# ri -,, .:
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City 1-:
Affected ❑ CW [Z EW E] PTA F] ES [7(] PTS Adj. Wtr. Body (riat(man/unk)
AEC(s): ❑ IDEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wen Body
ORW: yes/no,.` PNA: ye@r9q_—
Type Of Project/Activity Y`; a \eI, tt I),
(Scale: o )
Access Length --
Pier (dock) length
Finger pier(s)
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A building permit/zoning permit may be required by: kt �.>._..c r. on. , 4
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Sit --PI d I' It t "b it
f 't*• Si t
(Please Initiali� z-
gna ure ease rea camp lance s a emen on ac o perm) gna ure
Application Fee(s) Check N/Money Order Issuing Date Expiration Date
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
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Contractor
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to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
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necessary for the following proposed development: Ll 0-uL1
at my property located at
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in L County.
1 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:
ignature
Print or Type Name
Title
/ C) 1 '20 Z
Date
This certification is valid through I I

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:
Address of Property: i(o ✓ l+S IIIII L/j iI-es a79�9_
Mailing Address of Owner: /j 0
Owner'semail: Gr%f(2VC, Jo'Co0't owner's Phone#:
Agent's Name:
Agent's Email:
Agent Phone#:
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.
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.)
100 wish to waive some/all of the 15' setback
of Adjacent Riparian Property Owner
mc3
I do not wish to waive the 15' setback requirement (initial the blank)
,c Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:,�O0 _� X.;nsw.. � r OYP+ IJC 131 _
ARPO'semail: L0U ' eai( "C 4 (k)`'ARPO's Phone#: 2(Ito _ "1 `7 9>
`A Date: 10(( � *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:. �� ✓ /�I �5 o;
Address of Property: _ to *'Ltt� ,4r11 [_(9 e, f�j�,��1a'- P, Al—, "a�3
Mailing Address of Owner.. Ix) (k A4rll 6'L, C&dZy, 3 D.
Owner'semail: L�e `e�c�c�C�at Owner's Phone#: '7y3--Z07y-q6W
Agent's Name:
Agent's Email:
Agent Phone#:
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.
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
lea
I do not wish to waive the 15' setback requirement (initifo the blank)
�( Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: j D
a�132
ARPO's email: +ICI' r_ n(/k n Q�Akiiz,LOutl ARPO's Phone#: �52� '02— 4411
Date: U 2� J 1 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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