4-24 PERQ - Rose, Donna and Nelson

Elizabeth City Field Office 4.24 PERQ
Local Government Permit Number
Perquimans County
CAMA °``°ASrU�N,
MINOR DEVELOPMENT Z
PERMIT
as authorized by the State of North Carolina, Department of Environmental Quality and the
Coastal Resources Commission for development in an Area of Environmental Concern
pursuant to the Coastal Area Management Act, Section 113A-118 of the General Statutes.
Issued to Nelson & Donna Rose, authorizing development in the Estuarine Shoreline (AEC) at 138 River Shore Dr, in
Hertford, Perquimans County, as requested in the permittee's application, dated and received April 22, 2024. This
permit, issued on May 2, 2024, is subject to compliance with the application and site drawing (where consistent with the
permit), all applicable regulations and special conditions and notes set forth below. Any violation of these terms may
subject the permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: The grading, leveling and installation of a 24' diameter above ground pool and 2' wide border.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat drawing
stamped received by DCM on 4/22/2024. [GS 113A-120]
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations. [GS 113A-120]
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit. [GS 113A-120]
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work. [GS 113A-120]
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for
compliance. Any maintenance work or project modification not covered under
this permit, require further written permit approval. All work must cease when this
permit expires on: DECEMBER31,2027
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal
Management.
Check 047 , in the amount of $10o, was received on
5'/a1aoa4 for the permit fee.
Ron Renaldi
NC Division of Coastal Management
401 S. Griffin Street, Ste. 300
Elizabeth City, NC 27909
PERMITTEE
(Signature required if conditions above apply to permit )

Name: Nelson & Donna Rose
Minor Permit #4-24 PERQ
Date: May 2, 2024
Page 2
(5) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of Normal Water Level. [07H .0209(d)(10)]
(6) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filter cloth must
be installed between the land disturbing activity and the adjacent marsh or water areas, until such time as the area
has been properly stabilized with a vegetative cover. [07H .0209(d)(3)]
(7) Any proposed for grading within the 30' buffer from the Normal Water Level must be contoured to prevent additional
stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized and must remain in a
vegetated state. [07H .0209(d)(3)]
(8) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third -party. [GS 113A•1201
(9) This permit does not authorize development within any wetlands or open water areas. [GS 113A-120] and [07H
.0205(d)]
SIGNATURE:A��� DATE:
i
PERMITTEE

Locality
Permit Number 4 _aL\ Qrri2Q
Ocean Hazard Estuarine Shoreline ✓ - ORW Shoreline
(For official use only)
GENERAL INFORMATION
LAND OWNER - MAILING ADDRESS
Name / Y•p �So' 0 f to S L �( /Z
Address /38 12LL/eV DI(L
City ll fyU/t D State
r1e
Public Trust Shoreline Other
Zip0-7Ny Phone %S i � 373 - QL2%2
Email-JAttos6 1960 \ 6 M A I L -C_(X.
AUTHORIZED AGENT
Name
Address
City
State
Zip Phone
LOCATION OF PROJECT: (Address, street name and/or directions to site; name of the adjacent waterbody.)
15 A -if.1,
IL 2w e lr
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) Apo V e ifaoo.,ap
7
/5AC L �u}IzP
SIZE OF LOT/PARCEL: 3/00 a square feet 3 ` acres
PROPOSED USE: Residential El�/ (Single-family El/ Multi -family ❑ ) Commercial/Industrial Other
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: square feet (includes the area of the foundation of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State
Stormwater Management Permit issued by the NC Division of Energy, Mineral and Land Resources (DEMLR)?
YES NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
an owner or record title, Title is vested in name of _ N e iSw
see Deed Book d5 to 7 4 o L- � y N 9 page 39i' ie 3y in the County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in
County.
if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)
(1) 2*/r- C_A64`1"�L f�ZS r3re�rsH,�D�e e'tvv C�es,�I�q daazo
(2) /,22 Siyer+s" 37/2 Fwr+Ns.:ovadG. D2 Cheswtet10-VIA 357-(
(3)
(4)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I 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.
This the 2 z day of . , / 20
Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a check for $100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.

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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: A SO� 4 �s c T/L
Address of Property:
RECI" EC
v e &- gv� e PeL . 17 r v f,Co mo NC 7-
Mailing Address of Owner: S p 4-f ✓) /3o v<
Owner's email: fO "56 660 0 6~ -'6Swner's Phone#: 7> 7 37 9t° 7 4-
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
APR 2 2 2024
I hereby certify that I own property adjacent to the above referenced properly. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
V_ I-DONOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notary the mu. urvrsion or L;oasrat
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Grim 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 some/all of the 15' setback �i FaO
Signature of Adjacent Riparian Property Owner
-OR- I—
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: i /cJ1, 2
Typed/Printed name ofARPO: QA4<! Vno-9fel
Mailing Address of ARPO: Soil 9,4tn Q2,* Cl ea Urt a 3i,?o
ARPO's email:
ARPO's Phone#: 757 2 aY - 6 io v
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022
"A -EC

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY RECEIVED
(Top portion to be completed by owner or their agent)
Name of Property Owner: /Je/x , A 2. sg Ur, APR 2 2 2024
Address of Property: 0 8 (2LVe V— 3 Lo V v- I)rz y 14ek. sGro2p /i% v-7 i y G 11 flrEC
Mailing Address of Owner: S/d I AS 41�o a e
Owner's email: N jqk °Sc f 4 G o �Gnn+c' `Owner's Phone#: if 2` 3T3 —�6 7�
Agent's Name:
Agent's Email:
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
description or drawing, with dimensions must be provided with 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 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 oniv 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 riorap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian
Typed/Printed name of ARPO:
Owner: I C U C-/U
V4
Mailing Address of ARP�OC I \ l 7Z _ 1 � �
ARPO's em 'I: ���'' 1�\y�C RPO's Phone#: 1� lL/�� 2U4o;lp VA 4,
Date: 4 L 2')2 -waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

NC Division of Coastal Management
Cashier's Official Receipt
Received From:
�JLkSsn w ea -
Permit No.: U �7
Applicant's Name:
Project Address:
r
23090&s C v
Date• � 20
Check No.:
nn_
County: I't
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: �,`,',.�0:i rl/1. i Date:
Signature of Field Representative: Date: