89006A - Hughes, Kevin and Susan

IPCAMA ❑ DREDGE & FILL N9 89006 A B C D
aGENERAL PERMIT D tepre io slpermitissued
© 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. Syr General Permit Rules available at the following link: www.decimc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP a'? ) i 1
Project Location (County): : i•. �, .�.:.-�
Street Address/State Road/Lot #(s) 131 i
Subdivision `71s•- i
city ZIP
Affected ❑ CW EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body i *- `.=1.+•� :' sTtjjnan/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body A Ij.<rv�r,�; 4 `>...:� �l
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s),
Floating Platform(s) i
Finger pier(s)
Total Platform area
Groin length/q
Bulkhead/ Riprap length �_ ,•�
Avg distance offshore
Breakwater/Sill
Max distance/length a
Basin, channel fT
Cubic yards i r•-^•-- - ;��V4
Boat ramp }'
Boathouse(,B a'iG) 1,j A 1 .).
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: (fir/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required
Permit Conditions
(Scale: )
❑ 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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature**Please read compliance statement on back of permit** Signature
Application Feels) Check q/Money Order Issuing Date
(Please Initial)
f�
Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
kev to C SU Shn I
Address of Property: i -16 S CIO ho S Nor t? YJ'' I ✓e C'-1a ^ te^ VIC. 21(i3 l
Mailing Address of Owner: 5 bL^e 1 S A it cye
Owner's email: N �' u ;n N�,h�S 0 `jH P. 6r"a tOwner's Phone#: �GK ?1 q Zq I
Agent's Name: Agent Phone#: C�
Agent's Email.
/N /x
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 forthis
permit hayclescribed 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 nor ry me rv.L.. urvisron or 60a5far
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
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). f w' h to waive e setback, you must sign
the appropriate blank below.) 77 '�,
I DO wish to waive some/all of the 15' setback
M
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Property Owner
A
7s 6 36 - Z04`4
Date: Z-U \ *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: 14P—L) i r\ S U S,!)n NOn he S
Address of Property: &n +k,^ III C 'I—N*3 Z
Mailing Address of Owner: j rye h S o✓Q
Owner's email: 1401n "O)�S 01 IN P, 5t''0�Owner's Phone#: g1 (A), ( �
Agent's Name: /I/ /A Agent Phone#: NA
Agent's Email: /V(A
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 forthis
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.
ff 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
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
Signature of Adjacent Riparian Property Owner
rM
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian
Typed/Printed name of ARPO:n
Mailing Address of ARPO: �
,//�y� �Jn�V -�//B�y _ f��f /�7T%/ ��•ps/3Z
ARPO's email: At/f 19A2 eYJ/"il ARPO's Phone#:
�11 6 Jlv
Date: l7' �y Waiver is valid for up to one year from ARPO's Signature*
Revised July 2021