89031A - Thompson, Benjamin and White, Janece

notmr"EICAMA ElDREDGE & FILL N9 89031 A B C o
I GENERAL PERMIT Previous 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 Roy/CAMArules
Applicant Name _
Address
City
Phone # (— )
Email t_ 1, t
State
Authorized Agent 1
Project Location (County):
ZIP 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 Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length 03
Access Length
Pier (dock) length '>
Fixed Platform(s) i'., 'e L
Floating Platform(s) 1
Finger pier(s) i
Total Platform.dreq
Groin length/M 1
Bulkhead/ Riprap length
Avg distance offshore
Max distance/ length
- �
� i...
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift,
�k..S
Beach Bulldozing
,L
Other
1
SAV observed: yes no
- -
�-
Moratorium: n/a yes no
-- -
Site Photos: ,. yes no
Riparian Waiver Attached: yes no
i, '., ......
A building permit/zoning permit may be required
by: _
Permit Conditions
I
(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" SignatureN/ Application Fee(s) Check Money Order Issuing Date
(Please Initial)
Expiration Date

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RECEIVED
APR 1 7 2024
l.JCM-EC

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) J
Name of Property Owner: e!UjQ,n rV 7AIMOSUrV O/Vd //�NCGC lf%LI,IC
Address of Property: _h ✓Cm aJ1410 r f lizab eA'(;rfY. A/C 0279W
Mailing Address of Owner: S /./tn e
II dam rr /-3
Owner's email: h ret1J Q8 (o? Y040 Owner's Phone#: a ��D3 l
Agent's Name: "e.-%FhA-4^E_ 3nc Agent
Agent's Email:
zs�-331-�3(3
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 drawino with dimensions. must be provided with this letter.
/i.l-DO NOT have objections to this proposal. I DO have objections to this proposal.
H 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
1 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 rtprap 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) G
( 1�i KQo, Signature of Adjacent Riparian Property
/Owner:
Typed/Printed name of ARPO:
r 0 9
Mailing Address of ARPO: _ �D i7 _Burl a /I j%✓' r li e G" /i Z a-6 r✓'T� �'1>y, /1/ v2 %
ow
ARPO'semail: i/ie�i sc
fnbv (�J�'0�' ARPO'sPhone#:39
Date: �/�i0 h y —*waiver Is valid for up to one year from ARPO's Signature* RECEIVED
Revised July 2021
APR 1 1 2024
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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. )Am,u Ir0mtl56N aN,1 Jaryecc WtiAf
Address of Property: 56LA Sf1v°j1 /-1,zgLtjA C,j'X, irV i� a%9u7
Mailing Address of Owner. S UM t:
l,Cary
Owner s small: C i1 C (t 6 fv N .Z8 � yaarOwners Phone#: %?a LYd' - 96 3y
Agent's Name: L� ,.LJ, .d. n)p L Agent
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I 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.
_10rD0 NOT have objections to this proposal. _ I DO have objections to this proposal.
it you nave objections to wrier is osmg proposed, you must nodry me n.o. u,nsran yr w.a..r
Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be "
mailed to 401 S. GrIMn St, Ste. 900. Mizabeth CBy, NC, 27909. DCM representatives can also be
contacted at [phone]. No response Is considered the same as no objection If you have been
notMed by Certilled Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, idl, or
groin must be set back a minimum distance of IV 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 someiall of the IV setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (Initial the blank)
CRRPo)Signalure of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: Richard Wilson
Meiling Address of ARPO: 1215 Fairview Club Dr., Wake Forest, NC 27587
ARPO's email: richard.iwilsonAgmail.com ARPO's Phone#: [phone]
Date: 0411412024 'waiter Is valid for up to one year from ARPO's Signature*
Revised July 2021 R E C E 9\! E t'•'i
APR 1 1 2024
DCM-EC

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