89011A - Mitchner, Louis

:°`°""❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
❑v rNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N9 89011 A1; B
Previous permit
Date previous permit issued
C D
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 following link: www.deq.nagov/CAMArules
Applicant Name
e'er 6
Authorized Agent ���iT"r11� � .�VvS1 't
Address
Project Location (County): l ♦.i IC It ! -k, V (. --
City
State
ZIP r'
Street Address/State Road/Lot#(s)
Phone #
Email
Subdivision 1.4A 1. 1'� I) -i i ck VA.
City Er.,'_; r..1 vI-A ,,,j ZIP
t
Affected ❑ CW
❑ EW ❑ PTA
❑ ES ❑ PTS
t
Adj. Wtr. Body( ter: I,.; �. � i' ca .ritSvUCi s! 'yes �gr_t q (nat/manfUnk)
AEC(s): ❑OEA
❑ IHA ❑ UW
❑SPIMA ❑ PWS
Closest Maj. Wtr. Body ( , U t 4' 1 l U t:. i'- �:-%C` '1 r�
ORW: yes/no.
PNA: yes/no
Type of Project/ Activity
r
(Scale:)-3 )
Shoreline Length 1
r t._
Access Length
Pier (dock) length-�1---
Fixed Platform(s)
I '-
Floating Platforms)
Finger pier1s) 4 -
Total Platform area
Groin length/#
.-
Bulkhead/,,tiprap length I to-
r
Avg distance offisho Z
--j--------
Breakwater/Sill—
)-
Maxdistance/length40
Basin, channel %
Cubicyards
!!
Boat ramp 1
Boathouse/Boatlift
•'
Beach Bulldozing,-"±'"'
e�
j
Other
SAV observed: yes no J i "gly J-j�-tIMoratorium: r n/a yes noSite Photos: . yes no ---1 -`a I i --- -
Riparian Waiver Attached: yes no. ____ _ _ - _.
A building permit/zoning permit may be required by: i ,U 'r ! ll <- - r '
❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
t S, ! � ❑ 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 ft/Money Order Issuing Date Expiration Date

>�� 1THORIZATION Port re u n �RMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: (2S2) ?70 - 6152
Email Address: -- �- /J
I certify that I have authorized _/�?9i tvJ �6qS CO/?SG/G
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: -OZ I Of�C/
at my property located at _
in 6U6v-1.1CCiC County.
I furthermore certify that f 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:
�7 /J Signature
Print or Type N me
Title
Date
This certification is valid through

N.C. OWMION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER N071FICATIONIWAFVER FORM
CEzRMED M611 • RETURN RFrmpT RPf]r t�j°ED or 1, O nFi hvFRY
(TOP portion to be completed by owner or their agent)
Name of property pans,.
Address of Property. .
Mailing Address of Owner
Owner's email: hh _...... Owner's Phn oa#: iZ% 370--,)152-
Agent's Name: f/GiYllr SyNit7ij Agent Phone#: (L/F2�.7�/r d797
Agent's Email: •---,..__
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom oortlon is be com..ant Pnooartv Owner)
I hereby owilythat I own propertyadjaeent to the above referenced property. The individual applying for this
- parmit has described to me, as shown on the attached drawing, the development they are proposing, A.
LL ciftorlptlork or drawing, dimensions must k RMXlded with jos Mr.
I'DO NOT have objections to this proposal. I DO have objections to this proposal,
1 If you have objections to what Is being Proposed, you must noiffy the N.C. Division of Coaata/
Management (DCM) In writing within 10 days of receipt of this nodes. Correspondence should be
malted to 401 S. Gd in Sf., Ste, 900, EfizabeM City, NC, 27909. DCM representatives can also be
contaetedaf (252) 264-990i. No response is considered rho same as no objection if you have been
notified by Certified Mall.
WAIVER SECTION (Clwoss giity gnat
I understandthat any proposed pier, dock, mooring plimgs, boat ramp, breakwater, boathouse, lift, or
groln must be set back a minimum distance of IT from my was of riparian access unless waived by me
(ibis does not apply to bulkheads or riorao revetmentst. (if you wish to waive the setback, you must sign
the appropriate blank below.)
1 DO wish to waive some/all of the 15' setback _ a
OR -
Signature ofA jacent Riparian Property Owner
100 NOT wish to waive the 15' setback requirement (Initial the blank)
Signature of Adjacent Riparian Property Owne/ram A41'l�c V"
TypedlPrinted name of ARPO: / ty9t'1C ,�P/V'!,' /� Ale,
r_ c�
Mailing Address of ARPO: /1{% 5At% Ke er (� %`!/nGJ/r) /vie. ;?Vlag
ARPO's emallill l k �'UAY/f%n-°t ARPO's Phone#:
Date: �✓G-fDv `waiver is valid for up to one year from ARPO's Slgnatom-
RavisadAugust2022

FY*Imi
y .i.i. r _ r _• r r...
(ToP Portion to be ootnplated by owner or their agent)
Name of Property Owner: GlJli/5 /,/i 9'cyJ/ij
Address of Property: //Jr f///q ( lei
Meiling Address ofOwner. -//-- Lre5l—,.q7
Ownses small: ownses
ApWs Name: 'aanN
ADJACW RIPAMM PRCPMM OWNER'S CERTIFICATION
tDoftem DMNM to be eoKrNand av��eM,�gM
Iherebyrleralyttret lawn prop"adlewrittoftSbMflaftrenced property. The fndMdualappWoforthle
perms has deapPoed to me, as show on the attsohad drawing, fire dove}opment they am Proposing, g,
desaMon ar dre mim. wah dknarmiorta must be moulded wan, w kiW
rD0 NOT have otr ou m tp this propose. _____I oo rmve e*cdons to thk pmposaL
S.
nomadby
r.
I tmda eland that any proposed pier, dock, mo
profi rtnret be set beck a minkruan distance of
100 wish to weive aometak of the
m
I Do NOT wish to webs, the 15' setback Mqutramanf Qnft
Stgnehne of AMscmft RiPartmr Properly
TyPeWP*ftd name of ARPO:
MailingAftemof ARPO:
(umlar.�i ZdL
ARPO'B Wlag';Fr
of Uft ODOM Correspondence abooldbe
27MR. DCBf representallives am also be
Me same ea no obJecdon N you have been
boethouso. Uk or
blank)
iZ�.t �j4:><y Z•O�f�"�vni�t�Cc� �JG Z-1�L6'
s Phonet:. Z—S.-Z--,7--ti 7-- Zm75-
r
t-- j . 'weh'sr Is valid for up to one poet from ARPO'e SWAUt e"
Revised August 2022

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7,27,