87293A - Creighton, Charles

to
❑CAMA ❑ DREDGE & FILL N9 87293 A B C D
PreviGENERAL PERMIT Date uspousp
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:
1 SA NCAC ❑ Rules attached. [K] General Permit Rules available at the following link: wwwc1eq.nc.gov/CAMArules
Applicant Name
Address
City 'I State ZIP
Phone # ( )
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW FA EW X❑. PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. War. Body
ORW: yes/6o-' PNA: yes/I%
Type of Project/ Activity i ,, , \ Y I I , r !
(Scale:Q,1. S, j
Access Length'
(dock) length
Fixed Platform(s)
�EVENNESS
■■■r.Pier
OEM
�■���■■■�::::
Floating Platform(s)�_.0
■■ME
■■■
■..�■
■....
Total Platform area
■■■fI�l■!
■�
N�■■■�■■■
Groin length/#
Bulkhead/ Riprap length I,
Avg distance offshore
Max distance/ length
Basin, channel
Cubic yards
BBoathouse/ Boatliftoat ramp
Bulldozing
Other
p
:■:
■:■■■
:..�■■...■■.■.■■Beach
a■�
■■■
..
i
ONE
0
ME
1
p0
i
■:■:�:
SAV observed: yes no
Photos: yes no
Riparian Waiver Attached: yes no
:
::.
■
111111Site
..
A building permit/zoning permit may be required by: l� ��o wcr. lno,: ! '�* \1
❑ TARJPAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ 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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit*• Signature
)fS n It C1a�( (.,,r 13 Gps aLi qy
Application Feels) - Cheek#/Money Order Issuing Date
(jtg�aglw-�N-83a.a6A � P��a9)A-j HS,�a"�A)
(Please Initial) Y
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: CL' cyL Le-, ,
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
AU
N
L-�, , /UC 3 �
Cr e_('AA-hhn 0- Cc LA('-),'(e , C Jnti
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 6L"Ildlaz
at my property located at JL), 12 �2
in C lCounty.
1 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:
Signatt urre �
P int or Type Name
C.
e
3 l 1260
Date
This certification is valid through /

R
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
Name of Property Owner:
Address of Property: _
Mailing Address of Owner:
Owner's email: ` (1-AA
Agent's Name:
Agent's Email:
by "er or their
Agent
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 ,s being proposea, you musr noury me rv.". uiv,s,on or r.oasra,
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 scan
the appropriate blank below.) j n
I DO wish to waive some/all of the 15' setback
-OR-
I do not wish to waive the 15' setback requireme nitial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: -_o 0 U�/JdJ�v�r'�l2— (� j i
ARPO's a ail. O'JL1'(19" ARPO's Phonefl: r97(?.> /,f- %/i�o �
Dater I "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
Name of Property Owner:
Address of Property:
Mailing Address of Owner: _
Owner's email:
Agent's Name:
Agent's Email:
by yTer or their
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
7-4
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.
l..r[ 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.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 sian
the appropriate blank below.) //////JJ
I DO wish to waive some/all of the 15' setb� ��av[//
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: � Pdt/Pr) %ginpi l COr) )ARPO's Phone#: ` -50- 7.75ri
Date: ?i �� L� *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021