87264A - Patricia Jordan Trustee

"te"w �CAMA ❑ DREDGE & FILL
ff GENERAL PERMIT
tl5lNlew ❑Modification ❑Complete Reissue ❑Partial Reissue
Na 87264 C7 B C D
Previous permit
Date previous permit issued
As authorized by the S{aLe of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
ISA NCAC IT/ r �7. a� [-]Rules attached. General Permit Rules available at the following link: w—deo.nc.gov/CAMArules
Authorized Agent / . S -6 /!A W-1 kSL C=o t,
Project Location (County): Oq r7a—
Street Address/State Road/Lot #(s) Z- o '- V g r
2. y Cie
Affected ❑ CW 1r �Pffi ❑ ES ❑ PTS Adj. Wtr. Body L.n nII C a'ck4 I y na an/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal.Wtr. Body F /�C mo, �k-S-cvnd
ORW:ye no PNA: yesr
er
Fixed Platform(th
Flied Platforms) r
Floating Platforms)
Total Platform area ! 2-s
Groin length/N
Bulkhead/Rlprap length `
Avg distance offshore -�
�sner r +rs o. z. zq-A C-fi
< � o �.k�`\• n r�
SA� observed: I yes n�o �`l( I jj �y rJ l4 �.tLks
Moratorium: n a y_ s no
Site Photos: no PL
Riparian Waiver Attached: es no �v� �L
A building permit/zoning permit may be required by: 'y o .A n. o-C Kz It P% ,I'Z AA 11,5
Permit Conditions ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding giver 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) V-Irt'L .
pt, Monica L. M. Small y� J AAQ
Agent orlIApplicant
PRINTED Name Permiy1-t� Officer's PRINTED Name
'4- i ijoy �Cr.JJ •m((''
' A-tr6lwa Ce,,,,.)'>---
Signature '•Plea ead compliance statementon back of permit^ Si ature
y� L> 9 2- 3 2 Y�:21-2_y Ot 9/2-
Application Feels) Check N/Money Order Issuing Date Expiration Date

❑DREDGE & FILL N9 87264 � B C D
GENERAL PERMIT Previous permit
Date previous permit issued
Flew ❑Modification []Complete Reissue ❑ Partial Reissue
As authorized by the S%t�a[je of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC f"1 f �� �� ❑ Rules attached. Vq_Gerieral Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Na/ e
--+rjC i a.
tj, S u
G-1 r.-A �rwf�e-�•
Address 7r d1 ,
�oP� '.j
r
City i� I Iyn�
is l l� sI%tate
t4
ZIP 2-79 Y s'
Phone # (2s
-.s V 2—
Email Q In ci 6C`
4/� 2_gC
a�r/7
V-�
Affected ❑] CCW
nilW—
[T7i
❑ ES ❑ PTS
AEC(s): ❑OEA
❑IHA
❑UW
❑SPIMA ❑PWS
ORW: ye no
PNA: yes4i6
Type of Project/ Activity
Shoreline
Access Length
Pier (dock) lengthy
Fixed Platform(s) 15 K /s r
Floating Platform(s)
Finger
Total Platform area % ZS
ova
r fll, o Yl d,
�' eY ✓
Authorized Agent l ^^s < C: o rtS,
Project Location (County): �✓Q.iai._
Street Address/State Road/Lot #(s) L- o 'f �% c� r
1832-1 67 Dr.
Subdivi,syyn W rT 4 S ® «..T 5 e- c
city i 5 l I ® VVI l a-, zip Z77Ya'
Adj. Won. Body
Closest Maj. Wtr. Body /T I & 2 r ate( e_ -�' -u
�f XlS i �s K f5 o�an
jai (:
L I��
Groin length/#
Bulkhead/ Riprap length Q J F1�rN-p4jc! `/j(\♦
Avg distance offshore .. Breakwater/Sill OI-A-T Gp,h�
Max distance/ length
Basin, channel
Cubic yards "-
Boat ramp '-
Boathouse/ Boatlift
Beach Bulldozing / t
Other i t/tL s I s4-1
�J 6n
As"
SAV observed: yes sfgd,! I s✓ �Y A
n�o N ISnd s-�'
Moratorium: na s no
Site Photos: no PL
Riparian Waiver Attached: yes no ���� ��//
A building permit/zoning permit may be required by: �o aA A. t,(` � ki // D aJ: / YTT ffs
Permit Conditions
1 AM AWARE OF STATUTES, CRC R
Agent or Applicant PRINTED Name
THAT
Signature "Please read compliance statement on back of permit"
ya 3 2.32
Application Fee(s) Check #/Money Order
vaAlr CacV, f
(Scale: K(' )
❑ TAR/PAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Peimiitt Officer's PRINTED Name
Si ature Ot
r/�i�-Y Zr
Issuing Date Expiration Date

❑CAMA ❑ DREDGE & FILL NU 87264 A B C D
GENERAL PERMIT preepSperm``
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:
r
SA NCAC ❑ Rules attached. El General Permit Rules available at the following link: www.dea.nacov/CAMArules
Applicant Name
- -
Authorized Agent n n S.
Address
Project Location (County):
City
State
ZIP
Street Address/State Road/Lot #(s)
Phone #
Email
i
Subdivision
-
City : �. ZIP
Affected ❑ CW
❑ EW ❑ PTA
❑ ES ❑ PTS
Adj. Wtr. Body r (nat/man/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW
❑ SPIMA ❑ PWS
Closest Mal. Wtr. Body
ORW: yes/no
PNA: yes/no
Type of Project/ Activity
(Scale: rr_js 1
Shoreline Length -,
Access Length I -- -
N
S Pier(dock)length ,- -
t }y
Fixed Platforms) } �r_ ` 11 t --- a t , ii` it
Floating Platform(s) - - -
Total Platform area
Groin length/H
Bulkhead/ Riprap length
Avg distance offshore_
Breakwater/Sill
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift _
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: " n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: rrrz ,.A ry s•i M /ty 5 --� � ! YI �/ -I
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 N/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
V' l t Gr_ \ k4'\! C_ 21"V-M
143Z 9.S t -- 5S ('z
Email Address: '^ Q CO%
I certify that I have authorized
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:
a new walkway to a new dock platform
to extend my existing dock with
at my property located at t ,s32 .. �i.; v e Kt11H Iiy C
in -) 0rc ._ County.
I 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:
~ Signal t
Print or Type Name
Title
z /9", Izoz
Date
This certification is valid through I !

LSPROPOSED EXISTING DOCK EXTENSION @ 1832 BAY DR, KDH, NC
I j FOR PATRICIA W JORDAN & JERRY JORDAN
RIPARIAN DRAWING 1 OF 1 - 2/29/24 - NTS - BY: SCOTT C SMALL 1
MARINE! OF LSI MARINE - 252-473-7695 -- [e-mail]
Construction,_ LLC
I I
,
_ 1 NEW NEW PROPOSED
15, X 15, MOORING PILES
DOCK X zPLATFORM
I —
PLATFO
Ft-1
ROPOSED NEW t 1 ale — _
5 ..r5 �
�P 11
I ' X 45' DOCK �, � � i ��ba-o� -} .
- EXTENSION { 1 1 ly, el
0• ' EXISTING DOC,K
- EO WIT #
20'X 27
t 1
�—
-
ROOFSYSTEM
I
I I- �- - FFSE
I I- T I �— � I � � � � � �- ls� o
EX. B%kHEAD�
I I
' BAY DR
124.8 -�/- ~ y
I_
- I I !��IJSji�NZEIti
_ I -
1824 BA�'Y DRIVE - -
1832 BAY DRIVE
PO: MAHTANI
PROPERTY OF:
JORDAN
P/L P/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: PATRICIA W. JORDAN
Address of Property: 1832 BAY DRIVE, KILL DEVIL HILLS, NC 27948
Mailing Address of Owner: PO BOX 381, KILL DEVIL HILLS, NC 27948
Owner's email: GHJORDAN2 [e-mail] Owner's Phone#: [phone]
Agent's Name: SCOTT C SMALL / LSI MARINE Agent Phone#: [phone]
Agent's Email: SCOTT LSIMARINE.COM / MONICA LSIMARINE.COM
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be oompleted 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.
it you have objections to what is being proposed, you must no* the N.C. Division of Coastal
Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be
malted to 401 S. Griffin St, site. 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.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial
Signature of Adjacent Riparlan Property Owner:
TypediPrinted name of ARPO: SARA L KONSTANZER
Melling Address of AR(/PO: 1900 BAY DRIVE, KILL DEVIL HILLS, NC 27948
ARPO's email: y °t""l RPO s phone#: 2 � %
Date: 11 � I bit "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 NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: PATRICIA W. JORDAN
Address of Property: 1832 BAY DRIVE, KILL DEVIL HILLS, NC 27948
Mailing Address of Owner: PO BOX 381, KILL DEVIL HILLS, NC 27948
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: SCOTT C SMALL / LSI MARINE Agent Phone#[phone]
:
Agent's Email: [e-mail] / [e-mail]
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 Iy} th djltiensions must be provided wkh this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
IT you nave objections to what Is being proposed, you must notdy 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., Sta. 300, Elizabeth Clty, NC, 27909. DCM representatives can also be
contacted at [phone]. 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.)
DO wish to waive some/all of the 15' setback
-OR-
Signature ofAdjace taRiparian Property Owner
I do not wish to waive the 15' setback requirement (initial the
Signature of Adjacent Riparian Property Owner: r
Typed/Printed name of ARPO: NARATN S. MAHTANI & SANAM N. MAHTANI
Mailing Address of ARPO: 2126 ROLAND GLEN ROAD, CARY, NC 27519
ARPO's email :"'"'71p//G k icn?f) far rt<' ` A/ONRPD Phone#: :r 33 G aSq a rj
Date:waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021

Carver, Yvonne
From:
Sent:
To:
Cc:
Subject:
Attachments:
Good afternoon Monica.
Carver, Yvonne
Wednesday, April 17, 2024 12:13 PM
Monica Small ([e-mail])
Scott Small ([e-mail])
Jordan GP87264
JORDAN GP87264-RECEIPT-04172024115256.pdf
A copy of general permit (GP) number Jordan's development at 1832 Bay Drive, Kill Devil
Hills, is attached for your review. The pdf attachment also contains a copy of your receipt
for the permit fees.
To validate this permit, please address the following:
1. print and sign the permit on the bottom left-hand corner below your printed name,
2. initial where indicated on the bottom right of the permit, and
3. scan and send a signed copy of the GP back to me.
If you have any questions regarding this correspondence, please don't hesitate to contact
Thanks!
e�nne
Yvonne B. Carver
Environmental Specialist II
Division of Coastal Management
NC Department of Environmental Quality
252-621-6453
401 S. Griffin St., Suite 300
Elizabeth City, NC 27909
1

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