89003A - Wilber, Kerry

jj4L7CAMA ❑DREDGE &PFILL N9 89003 A B C D
GENERAL'PERMIT Date Previous previous
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 Tr) I ) `'—' ❑ Rules attached. [9 General Permit Rules available at the following link: wwwc1eq nc gov/CAMArules
Applicant Name ), , . I )-, Lt.. h t I
Address �� 1 `( l" e, �. Pout tic .�
City GL, 1 1+.; i .1 State 2`, i, zip
Phone#(do''4) ",11 `'
Email
Authorized Agent 1'
Project Location (County): ile ✓r..,
Street Address/State Road/Lot#(s) 19�
Subdivision
City Ft'
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body f (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/fio PNA: yes/no
Type of Project/ Activity
(Scale: f, I.� )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
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: ......
❑ TAf{/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ 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#/Money Order Issuing Date
Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY REC I / E D
(Top portion to be completed by owner or their agent)
Name of Property Owner.
Address of Property: _
Mailing Address of Owner:
Owner's email:
Agent's Name:
Agent's Email:
Pi Z U vf�
APR 1 6 2024
IA -EC
Owner's Phone#: 23 1 -28 % -2�W
Agent Phone#:
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 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 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 rea o ri avian access unless waived by me
(this does not apply to bulkheads or riprap revetment . (If ou v�� setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
ma
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: J JLc) ; S 11. 1 / U /_� N -e—
Mailing Address ofARPO: Ze 1Flu ��T ( L04&'l>/P /l�� 77
ARPO's email: _ ARPO's Phone#:.251.22 ' 2,k� y
Date: - X, *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1, 2, and 3. A Sig e
■ Print your name and address on the reverse X �� ❑ Agent f
so that we can return the cs,a to you. - - ❑ Addressee
w '.r A the mailpiece, B. Received by (Pq'nfe_d Neme) C. Date of Delivery
�G-u� d 0/-g-1N
- D. Is delivery address different from Item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
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9590 9402 8640 3244 9663 98
7020 2450 0001 0555 6530
PS Form 3811, JWy2020 P$N 7530,02-000-9053',
Service Type
❑ Priority Mail Express®
Adult Signature
❑ Registered Malin"
Adult Signature Restricted Delivery
Aft l'jered t fiVeslrloted
Certified Mail®
Cedlfled Mall Restricted Delivery
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❑ Signature Conflrmatlon'a
Collect on Delivery
❑ Signature Confirmation
Collect on Delivery Restricted Delivery Resirict D rye
h• •ed Mail
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Domestic Return Receipt

4/40124, 9:51 NM USPS Tracking Intranet
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Product Tracking & Reporting
1.1SPS'T'raclsing Intranet
Delivery Signature and Address
Tracking Number: 7020 2450 0001 0555 6493
°I This item was delivered on 03/1512024 at 19:13:00
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03/11/2024
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