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Home My WebLink About87297A - Creighton, Scott and Marshall�°"°"" GPCAMA [I DREDGE & FILL N9 87297 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: I SA NCAC ❑Rules attached. Ni General Permit Rules available at the following link: vrwwdea nc gov/CAMArules Applicant Name 1 f 1 Address - - — City State ZIP I Phone # ( ) Email ram• Authorized Agent 1 -k, 0 Project Location (County): Street Address/State Road/Lot#(s) t. Subdivision City Affected ❑ CW ❑ EW ❑ PTA Q ES ❑•% PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body ORIN: yes/no: PNA: yes/no Type of Project/ Activity (Scale:lj 'T. (;. ) cFnwn!ina Inn Access Length II �■ �■ l�■■■■ ■■�u��■ ■■■■ ' kII lengthFixed Platform(s) �i■■®■®�RI ■■ ■ ■■■' Floating Platform IIIIIIIIIIN M 0 DIY MEMO oil 1 ■ i ■ �� ■d■■■Groin ■■�■..■■ length/# Bulkhead/ Riprap length Avg distance offshor ■ ■ R'1■ � ■�■■■■N �IN M�� ■ ■■ Ali■■p■■ ■■■■■�■■■ ■ �■. C•®�■Boat ..�.I Cubicyards EKE 0 Z ramp MM 00 ME or low Boathouse/ Boatlift M No A building permit/zoning permit may be required by: 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) X Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature "Please read compliance statement on back of permit*• tignature afSr, t eH )L G, i3t,ps a4clLl J.) / : aL; Application Feels) Check oney Order Issuing Date - Expiration Date was-IasbA,#g7FA91h AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit Mailing Address: C�" Phone Number: Email Address:/�� I certify that I have authorized �� (/<� ` �(ll - Agent I 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 ine�'I?C County. ,4,0 ' - P�T� 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 (honer Information: Sjgndf Print or Type Name Title Date This certification is valid through 0 N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER N0TIFICATI0NIWAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: () el Address of Property: _ U ( Mailing Address of Owner: / Owner's email; Agent's Name: Agent's Email: /4. r C1- Agent Phone#: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent 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. !f you have objections to what Is being proposed, you must notrty the fv.c. urvrsron or Coasia. 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 (252) 264.3901. No response is considered the some as no objection ifyou 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 15from 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.) I DO wish to waive somelall of the 15' setback y�l C f�.t�.tL.4r7T� ./''lii/.lfi (SrrIQ Signature of Adjacent Riparian Property Owner -OR- I do not wish to waive the 15' setback requirement (initial the blank) rdb . M/1/✓/�lsEl2 Signature of Adjacent Riparian Property Owner: /H�5'�/�rJ Rt-R_ 1.`i i _�Pftr)FF/elltS/ LLL Typed/Printed name of ARPO: V//LL/fi/ f F.. r 14,0; PJ MFiA✓Ada Mailing Address of ARPO: 2/0 hll i�f)tilVG ARPO's email: v�9 'lPsf // r' aMa (,L;pm ARPO's Phone#: 2,_4 y'?4 /i1f/2 Date: "waiver is valid for up to one year from ARPO's Signature' Revised July 2021 L 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 Properly: -- Mailing Address of Owner: (�,1 o'v/Zl��l �Cpl�ll�.?" 7 Owner s P> e#: 6wr er's email! Agent's Name: Agent Phone#:___. Agent's Email: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent 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 noury me rv.c. Yrvr'srp1J Ur Uvaaaar Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be malled to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264.3901. No response is considered the some 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 ripadarr 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 propriate blank below.) 1DO wish to waive somelall of the 15' setback } v Signgture of Adjacent Riparian Property Owncr -OR- I do not wish to waive the 15' setback requirement (Initial the blank) _ Z� Signature of Adjacent Riparian Property Owner: j TypedlPrinted name of ARPO: Collin H. Johnson as PoA a ent for Beatrice H. Johnson / Mailing Address of ARPO: 10 Orchard Ave Waltham MA 02452 / ARPO's email: collin.johnson@gmail.com ARPO's Phoned: 805-215.9169 / Date: 3/12/2024 'waiver is vaild for up to one year from ARPO's Signature* Revised July 2021 - , �, 49 J ! � `"de. —� 1 K L •. � A � �, t f G>`. �� .ec y4, .PAQ.4 � ; n � hrw s E� ..r na F� 5 � .+, P l�� A , �j ` �� e �--.� �'�,. a1j{�) may- ��Y y ,a. t' r ➢�" � � � s �'2 tq �� t��'-*f e Y sia '£,�r, }� �(f 1 �/. y is 5 Y 6 � Y !ei/fl k' � - S � �«}� 2� %� . / /)� «^-�� x� y.. � �.�2® .