92273A - Harrell, Webster

���`°""%❑CAMA ❑DREDGE & FILL��v N° 92273 A B C D
GENERAL Previous permit
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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.goy/CAMAruIes
Applicant Name
City State
Phone # ( )
Email
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
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 i', '• I'-n I .f. r
(Scale: )
Access Length
Pier (dock) length
I
T
Fixed Platform(s)
Floating Platform(s)
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Finger P Ier s
Total Platform area
Groin length/M
Bulkhead/Ri ra length
__ Riprap gt r
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1
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Avgdistance offshore
Breakwater/Sill'
Max distance/length
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Basin, channel
Cubic yards
Boat ramp
Boathouse/Boatlif[
Beach Bulldozing
Other
SAV observed: yes no '
Moratorium: n/a yes no
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Site Photos: yes no
RiparianWaiverAttached: yesr-
a
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A building permit/zoning permit may be required by:
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 Permit Officer's PRINTED Name
Signature *'Please read compliance statement on back of permit'* Signature
Application Feels) Check#/Money Order Issuing Date Expiration Date

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: Z c be Vill Ae/ Nar'.c I I J r
Address of Property: .Sq I.vai <,.. A! Jk fc7ck 6s11-cf,,11< rVC 27939
Mailing Address of Owner: 59 Nrrnu e / iv, g,( GN 'kS_. It c n/ ( 8 -7 `f3
Owner's email: btkrre itc,p{L_41.11a0. U-I Owner's Phone#: .QS-a -333 -nao g
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Agent Phone#: z :
Agent's Name:
Agent's Email: FE0 1 9 20M
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION !� /t ( e
(Bottom portion to be completed by the Adjacent Property Owner) G IVI"I�`-�'
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
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.
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
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'setbadita�
�/ attuure of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: V
Typed/Printed name of ARPO: i�6Ns S rDlmctnl
Mailing Address ofARPO: 1-75 Truf✓115- Pet Rdbb1,.1/e VC 97CUS
ARPO's email: NA ARPO's Phone#: ffiD ��-331-33(00
Date: 'waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

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