87243A - Birdsill, Richard

�00M74` [WCAMA X DREDGE & FILL N° 87243 � B C D
GENERAL PERMIT Previous permit
+ Date previous permit issued
V 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 IIOC) ❑Rules attached. General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Rt („ Eta r A C-. 6 J f 0&-.l 1
Address 101 DC. Nwaoc3 WAO-IZJ9 t cl
city lkv- - V i dl State N t- ZIP X4 01 4 4
Phone #(J!a) 408-0a�3
Email L° 0li+ .n io R Li P CGX
Authorized Agent Mark 'Tti�.v,OSw.
Project Location (County): Pe vi". � n
Street Address/State Road/Lot#(s) 10-3 YIn.Ewaud r4x:d
Lot d-A
Subdivision NSlrelc.,, TSlcn
city I (- 11-61 dd zip ;1-+94y
Affected ❑ CW EW PTA K ES PTS Adj. Wtr. Body a 1 Mo J IL ` e a , cl ( Wan/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body A1\if ..n o,�t Svp``
ORW: yes PNA: ye io
Type of Project/Activity tZtPlat_- t}+O' ,� (,IK1..tcf Twv ,Sty'} Wnit+wcJa u1 e S'i•Irti au\kL—d
A ao' fLL. L3 rr+ (Scale: IViS )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Ikh iprap length ± +0'
aI
Avg distance offshore
Nw�
Breakwater/Sill
Max distance/length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
J
Beach Bulldozing
O
Other
ti
hv�rhor.2ld (,iJ\wive d
—.—. — — — —IC——
.7^
IEr 6..IK1.1.2 @ L, i—
i 40 .
SAV observed:
yes
Moratorium:
yes
no
Site Photos:
C-05)
no
Riparian Waiver Attached:
yes
6°
A building permit/zoning permit may
be required by: Pe4 . rt.,.,
Permit Conditions
(
17u' \\
2ttrrn� pA\\qnC
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional
I AM AWARE OF STATUTES, CRC RULES AND C DITIONSTH T APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Pleaselnidal)_�
Age i antP E Name Permit Offi NTED ame
Signature * Please re compliance statement on back of permit
4400,00 413u/d.oa.y J"K/ao').y
Application Feels) Check#/Money Order Issuing Expiration Date

dtoNr" %❑CAMA ❑ DREDGE & FILL ND 87243 A B C D
GENERAL Previous permit
AL PERMIT i 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgq.nc.Rov/CAMAruIes
Applicant Name
Address
City State
Phone # ( )
Email
P
Authorized Agent i"..'
Project Location (County):
Street Address/State Road/Lot #(s) _
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes(fio PNA: yes/no
Type of. Project/ Activity
(Scale: )
Access Length-'..
Pier (dock) length
Fixed Platform(s)
I
1
L�
o-
I
I
r`
_
-
I
Floating Platform(s)-
Finger pier(s)
�_
�—
_-___..
-
--L
-
--
__I_y
Total Platform area
Groin length/q
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill •��
_
-
__
-
_
-
_I
A
G
k h
r
rr.
e'`
1 V
`,.."_`
�
--{
--
-- ----
.
I
--
x
(
"
IG�
c
wl
!
�•
`
Max distance/length
Basin, channel
-
+
I
I
Cubic yards
Boat ramp
Boathouse/BoatliftJ
Beach Bulldozing
Other
__
S,.
i
1
u(u
i•.
-
S
{
L
1
i
1
I
SAV observed: yes no
!—
Moratorium: n/a yes no
SitePhotos: yes no
Rloarian Waiver Attached: yes no
r
!
-- --
-
_
-_
__
E _
I
-
A building permit/zoning permit may be required by: IMP r�) : (........ 1 y
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)
Agentor Applicant PRINTED Name Permit Officer's PRINTED Name
Signature *Please read compliance statement on back of permit** Signature
Application Feels)
Check#/Money Order Issuing Date
Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
�e�ct�a L 13���ISJ 11
Mailing Address:
/0 3 D & �o
#t�rrCxZz W L av h'
REGE VF
MAR 2 5 2024
!✓MEC
I certify that I have authorized (agent) 11% \ / /7U/Y)%�ON (14-W C)to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) NlV
$Jl t
IqE-�
>
at (my property located at) /0.3
D,ev-(-J00�
PA
A�TnL % N(�-
This certification is valid thru (date)
Property Owner Signature Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY RED-,F-IVED
(Top portion to be completed by owner or their agent) ll e. 4
Name of Property Owner: TRICh4x- X 4E L?, ''J S rNS
MAR 2 5 2024
Address of Property: 0Qf-z000�.�)Gft
Mailing Address of Owner: SA-rv) C
Owner's email: 6fl"o0 d C'-qy, Owner's Phone#: Z7- Y�Ly 02
Agent's Name:MAe)L
Agent's Email:
Agent Phone#:(p
\ . f a i",,
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 is being proposed, -you 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 (Choose only one
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 somelall of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank i
Signature of Adjacent Riparian Property
r Owner: f
/LOCH
Typed/Printed name of ARPO: • �'�' • bA LOC 11
Mailing Address of ARPO: %D� /D/-X � j,, � Rd Afe-zibfC 1NIC
ARPO's email: ARPO's Phone#: 0 - l 3 ( e e- A
- �11a-L-/S7J ``J le
Date: 3 -- L 7- t/ *waiver is valid for up to one yearUm ARPO's Signature*
Revised August 2022

4/29/24, 7:49 AM Gmail - (no subject)
N,C. OMSIc3N CP
ADJACeNT RIPARIAN PR®pER fYCOASTAL; MANIAG
,Ri1WIMAu fitur�N OWNER tonrtc
It
(TOP portion to bo compiQted r
dQsrrws of Prolmly Owner:
Address of property:
A1ai#in9 Address of Cnvnw: —
CTrntar'o emai > a Owner M p 14:: d hone# l�'-vas
A9ent'sNam: QarQi!,. Agent Phonalt:,(� n f
Agent's ElAW:_%t�11t7tI��z��i?��x"_r1RM.1 x��µ
'Ab.1A(:FNT DIDADIAu
Iherebyceitfythatiovnipropertyodjaconttotheabovereferencedproperty Thu individuslappyfngforthi 9 permit ties doscribed to ate, as $flown on the attached dr awing, the davetopment they are proposing I„S ' descr: ti n_orcit `pg,.xryt�i e s t1s mustboorovldodK�ihiM<(ett�o-, '
I'DO NOT have objections to this proposal. I t10 have objections to this proposal.
I! you hh�vo obJoeNons to what (s befn� "` "�'"
g p posed, you must nobly the N.d. DMsion of Coastai
Management (DCM) In writing within 10 days of receipt of (his notice, Correspondence should be
matted to.401 S. Of"n St., Ste. 300, Wizaboth City, NC, 27909. DCM representatives can. also be
contacted of (252) 204-390i. NO response is considered the same as no objection if you have been
notified by Cortltfed Mall..
WAIVER SECTION.(Choos® onl9 oeel
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be setback a minimum distance of IT from. my area of „ riparla access unless waived by me
(this does not aopiv to bulkheads or dorao revotmenis)1'you Wish toZaNa tha_satbark vn ...4 er....
I DO wish to waive some/all of the 16'
-OR-
I DO NOT wish to waive the 16'setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: _YSI�.��i,,,1 [rr^
J
Mailing Address of ARPO: "
ji � 3 iRo tie �fi��en__�x y
ARPO's small: )031
Date: ptnOc,..,.i'-foc
__..t ARPO's Phone#: 21Y _ 11.I�y�/L
� �MR11, �r✓1
_`waiver is valid for up to one year from ARPO's Signature'
Revised August 2022
https:llmail.google.com/mail/u/0/?ik=6le9fe72f5&view=pt&search=all&permthid=thread4:1796330390107098118&simpl=msg-f:1796330390107098... 11 /12

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MAR 2 5 2024
DCM-EC

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