89010A - Queen, Charles and Karen

MCAMA ❑ DREDGE & FILL N9 89010 A B C D
` Previous permit
GENERAL PERMIT 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.deq.nc.gov/CAMArvles
Applicant Name 4 1 , i
Address^, r , t iC.\J.Y <., (_n
City i (";,I State i`•' c.. ZIP
Phone#(�_) %lfAtr -}L4cj
Authorized Agent
Project Location (County): Pl �a 1 . , lC
Street Address/State Road/Lot #(s) 1 7) & t , c � 4„ i, t s, . i. �,, i _x
Email (Dc r,. -A C,.v.� Subdivision
city C" h ;._ I a I, 0 ! a ZlP i "10 `I
Affected ❑ CW ❑ EW 4 1 PTA ❑ ES ❑ PTS Adj. Wtr. Body (le, r U (nat/tfaari/unk)
AEC(s): ❑OEA ❑IRA ❑UW SPIMA ❑PWS Closest Maj. Wtr. Body lix �ca,..�-<.:�ti.. /<,v<.✓
ORW: yes/(tq.,' RNA: yes/So T
Type of Project/Activity n.vC Cx0t F1x.! jn+. jn j(-w. o—,,% J&plr.:.,- ,1 w.>L" a Floe n e
t 01. ,v +uuc� S.a+- w,1t., i :. ..;ti,v.nf-� 1:; ,1olt ru.�.. I,r is" iik, ii (Scale:U,T,S.)
Shoreline Length
Access Length-
i
Pier (dock) length { I�
Fixed Platform(s) �:: +N.i`k''-` I I I i i I' . N
Floating Platform(s) F-1.� t - YI¢G_-�-'
Ir.. t ( _
Finger pier(s)
Total Platform area
Groin length/M
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 f�
Moratorium Ch(a)
yes no �-
Site Photos.:"
yes no I
Riparian Waiver Attached:
yes a _
A building permit/zoning permit may be required by:
Permit
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
,r♦/
TAM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROTECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
^i l
Signature "'Please read compliance statement on back of permit"
Application Feels) gheckN Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

APR 16 2024
N.C. DIVION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORJD `✓ 1 V I — E C
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner `_ k- VJ/
Address of Properly: 1t,"c-Y._fot/St:.
Mailing Address ofOwner
j�i�1C
Owners email ' N- i Owner's Phone#
Agent's Name:
Agent Phone#.
Agent's Email:_ _
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner;
hereby certify that 1 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 i DO NOI' have obiecf+ons to this proposal. __ i DO have objections to Bus proposal.
if you have abjechons to what 6 beuug pn*oseA you must mMy the N.(» L4vismn or Coastal
Management (DCM) in writing within 10 days of receipf of this notice. Coemspondence shouhi be
mailed to 401 S. Griffin St, Ste. 300, Elaabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 2643901. No response is considered the same as no r4acthui 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 siqn
the appropriate blank below.)
I DO wish to waive some/all of the 1 S' setbac,: ),
Signalu of Adjacent Riparian Property Owner
-OR-
Y do not wish to waive the W setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO
i, /
(Mailing Address ofARPOc,-
ARPO's email: _.._ .<: i1� /�L,/. MIS__ ARPO's Phone#: 2
Date_—_S�_L,�,1G„'waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

e
APR 1 6 2024
.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFtCATIONIWAIVER FORM✓CIVI-EC
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agem,
Name of Property Owner
Address of Property_
�J:�'� __- ifs (I r.
Mailing Address of Owner. i/lV I L
Owner's email Owner's Phones:
Agent's
Agent's Email:
Agent Phone::
ADJACENT RIPARIAN PROPERi Y OWNER'S CERTIFICATIOi _
(Bottom portion to be completed by the Adjacent Property Owner;
hereby certify that l own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as sttown on the attached drawing, the development they are proposing. A
descriptio�p-or drawing, with dimensions, must be Provided with this letter.
100 NOT have objections to this proposal. i 00 have objections to this proposal.
If you have objections to what is being proposed, you must notify Me M.C. Division or Coastal
Management (DCM) in wr&ng within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Grim St., Ste. 300, Et2abeth City, NC, 27909. DCM representatives can also be
confacted at [phone]_ No response is considered the same as no objection If you have been
aotftied by CertfTred Mali.
WARIER SECTION
I understand that any proposed pig, 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
Hie appropriate blank below.)
I DO wish to waive some/all of the 15 setbacR rr
Signature of Adjacent Riparian Property Owner
-OR-
1 do not wish to waive the 15' setbackk requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
TypedlPrinted name of ARPO:--i.�>d
Mailing Address of ARPO: i 3 f.-
r
ARPO's email: (: ARPO's Phonefr:
Date: _ *waiver is valid for up to one year from ARPO's Signature=
Revised July 2021

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