87176A - Walsh, George and Kathleen

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❑CAMA C7 DREDGE & FILL N0 87176 A B C D
Previous permit
GENERAL PERMIT Date previous permit issued
❑ 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. r❑'. General Permit Rules available at the following link: www.deo.nc goy/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State
Authorized Agent
Project Location (County):
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 Maj. Wen. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: )
Access Length
Pier (dock) length
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SAV observed: yes n1cJ
Moratorium: 0?a� yes no
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A building permit/zoning permit may be required by: (. �" a�. l r% n fn •.r� l .
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Permit Conditions
❑ 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. (Please Initial)
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit**
Permit Officer's PRINTED Name
Signature
Application
Check g/Money Order
Issuing Date
Expiration Date

Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
5
NW 1 155
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to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: F AA -/�
1_ titl_ 1
at my property located at
1 furthermore certify that l 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.
Property Owner Information:
'pnature
91101(j MW-I-irlt 7. Walsh
Print or Type Name
Wf(ME2
Title
Date
This certification is valid through ,]!) 1 a5 1 05
MAY 13 2024

R -t' g N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
MAy 13 2(11i, CERTIFIED M61L - RETURN RECEIPT REQUESTED or HAND DELIVERY
{��, (Top portion to be completed by owner or their agent)
L)CName- of Property Owner. UAL
_
Address of Property: a3 {L fJ CUL
Mailing Address of Owner.
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Owners email:
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C4Y� Owner's Phone#:(5' 10,�I�
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Agent's Name:�12
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1tvtR4Git iP�i-i*ent Phone*
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Agent's Email:
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1 hereby certify that I own property adjacentto the above referenced property. The individual applying forthis
permt has described to me, as shown on the attached drawing, the development they are proposing. A
7 r I DO NOT have objections to this proposal. I DO have objections to this proposal.
a , n , ... ,... _i
n you have objections to what is being proposed, you must notary me NX. Urvisron or coastai
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. GrWn St, Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted of [phone]. No rdsponse is considered the some as no objection It you have been
notified by Carttfied 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 rlprap revatments). (if you wish to wahre the setback, you mustgjan
e appropriate blank below.)
I Do wish to waive sometall of the 15' setback
Signature of, r((acent Riparian Fropaq Owner
-OR-
I do not wish to waive the 151setback requirement (initial the blank)
'signature of Adjacent Riparian Property owner.
Typed/PrInted name of ARPO:
Meiling Address of ARPO: dor Y . f• -i�,� f N C 2193 a-
ARPO's small: ____ IAJRPO's Phone#: 1q' V - A3
Date: �IP51ZQ*] 'waiver is valid for up to one year from ARPO's Signature"
Revised Juty 2021

r K ',•; r+.s j1
C ) ¢ N.C. DM&ION OF COASTAL- MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
�' RTIFI D MAIL •RETURN RECEIPT RJ; G1UE�0 or Hgj+jQ DEl11rERY
MAY 13 N24
C;J'Jj- a:C'
Address of Property:
(Top portion to be completed by owner or their agent)
Mailing Address of Owne
Owner`s email: IpQ fi ytn5lq ai a4 COm Owner's Phone* (51ty )3i3 - qQ3
Agents Name:
Agertis Email:
I hereby certify that I own property adjacent to the above referenced property. The IndhvfdUal applying forthis
perm 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.
%- Ia55 Lfi of vaih.at, IMIk-k#AA
n you nave objections to what 15 ba1Rg proposed, you must notify the N.C. Division of Coastal
Marutgement (DCIM In writing within 10 days of receipt of this notice. Correspondence should be
mailled to 401 S. OrMn St, Ste. 300, Elizabeth City, NC, 27909. DCAf representatives can elso be
cordr-ted at [phone]. No rdsponse is considered the some as no objection H you have been
by Certifted A9ai1.
Iri101T4IGNi
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lit, or
groin must be set back a minimum distance of 15' from my area of riparlan amass unless waived by me
"is does not apply to bulkheads or riprap revetments). (Ifyou wish to w to etback, you must III
the appropriate blank below.) /
I Do wish to waive some/ail of the 15' setbacl�/�!
Signatrue ofA*w1# Rtp&14n Propary
OR -
I do not wish to waive the 15' setback requirement (InIllptfhe bank)
­
ature of Adjacent Riparian Property Owner.
r
t I .sl.l. r �i@IMNIONC..
Date: •waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021

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