89033A - Wysor, Benjamin

,&"(0mr"" QCAMA ❑ DREDGE & FILL N9 89033 A B C C
GENERAL PERMIT Previous permit
s 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. M General Permit Rules available at the following link: www.de I.ncgov/CAMArules
Applicant Name
Authorized Agent r: -,_ 41 .- ..
1—'-. r: / , r•.. .A t-• r
Address
Project Location (County): a r
•n iw
City
State
ZIP
Street Address/State Road/Lot
I.1 k: CI I Id
Phone # (_ )
Email
Subdivision
City ) - kaa t I, f - ) .i
ZIP �' 1 •i o `r
Affected ❑ CW
❑ EW ❑ PTA
❑ ES ❑ PTS
Adj. Wen. Body I'ut , Iyitc
n r t..1L.- �Triatlman/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW
❑ SPIMA ❑ PWS
Closest Maj. Wtr. Body �° -,"Iva.
)-c: • k� V'< /
ORW: yes/nb i
PNA: yes/no
Type of Project/ Activity •. / f , ; 9 1, 4 k o.. rt <a 'k It' L. x 3' U,/
(Scale: prCS,
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) /l
i Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift 1 a
Beach Bulldozing
Other
SAV observed: yes (.-�o-)
Moratorium: � n/ayes no
Site Photos: yes` no
Riparian Waiver Attached: yes no
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.
Agent or Applicant PRINTED Name
Signature *'Please read compliance statement on back of permit"
Application Feels) Check q/Money Order
Permit Officer's PRINTED Name
(Please Initial)
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 3ifWT Vh / P 1VVY15bK.
Mailing Address: 1 1 6 old MG Donti 4C JI
Phone Number: ZSL- 531 77 % I
Email Address: 'T�� �e c�/���� fe4J&/
I certify that I have authorized >t C
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
atx-C)LIV0,0410 Rate-I'14 )K
at my property located at
in v br County.
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:
z SignMure
ol�Thr, IN & VJYSDYL
Print or Type Name
fiwh�/
Title
/1 // l ^
Date
This certification is valid through

OD _
/ 0C
v
a �
C
�
C
CIOr
1(1

J
n _s
o �
J � r
(' Fo o o

RECEIVED
N.C. DIVISION OF COASTAL MANAGEMENT MAY 0 7 2024
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
(Top portion to be completed by owner or their agent)
Name of Property Owner: >E NSs'MI N 6 ws o t?,
� r
Address of Property: ' 7O o u KCDOVA U ?,<—' F—) 44, C
Mailing Address of Owner:
Owner's email:*«ecy�
I •C*w
owner's Phone#: [phone]—8 8
Agent's Namelei ergs✓ c1, 1nL Agent Phone#: 6313
Agent's Email:
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 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' setback
Signature ofAdjacen Ripar' Property Owner
-OR-
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: /%�/ ")Z O X0140
ARPO's email: ARPO's Phone#: ljpel_Jv j
Date: Y a *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

C)
11l
UJ
C-
U
IVN

CRIED
N.C. DIVISION OF COASTAL MANAGEMENT MAY 0 7 2024
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM p�ry �
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY �,�C�1`�!4 r
(Top portion to be completed by owner or their agent)
Name of Property Owner: --b eriy.M iy ^G W yso12
Address of Property: Of 0 1d- lY `G Dc v%c, « E11-Z k i2e ^ Cf � I y
Mailing Address of Owner:
CA&-#
ff ;t .dew•
Owner's email: 4�4 f �CWreAq<r &4r Owner's Phone#: [phone]AT
Agent's Name: IGNdt4n /%lgi n C . Trtt_ Agent Phone#:
Agent's Email:
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.
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 rtsi,
the appropriate blank below.)
i
I DO wish to waive some/all of the 15' setback
of Adjacent Riparian Property Owner
Silva
I do not wish to waive the 15' setback requirement (initial the blank)
v Signature of Adjacent Riparian Property Owner:
+ Typed/Printed name of ARPO: c7eo-Il,nft2 J f; N N i 0(;—S
x Mailing Address of ARPO: O J JM41-1- t) (2 CC- t t `�
2 /
ARPO's email: ARPO's Phone#: 7 �u � K �G J 1O
t Date: 4 2 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

ICJ C
> LLB
uj o
0
c