89060A - Tedesco, David and Sharon

d'`0"'� A CAMA ❑ DREDGE & FILL N° 89060 (6 B C D
GENERAL PERMIT Previous permit
Date previous permit issued
BIFX]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 f / ! i I ) (:,(., ❑ Rules attached. D General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP -
Phone # (''!' !!)
Email
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW DEW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body ! > -
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
-
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: 1
Shoreline Length
Access Length
--
--
—
-
-
-
-
—
—
Pier (dock)length
(s)
Fixed Platform.._
_i-_
_
(
_—
__
_
!-:
ti*?---
__I_
_�t.•
.�
_1
.—
�__
—
FloatingPlatform(s)
I
Finger
pier(s)
�A
Total Platform area
Groin length/q
a-
- _
-
-�
--._
1
s7
—
I_—
--._
Bulkhead/Riprap lengthAvg
distance offshoreBreakwater/SillMaxdistance/len
Ji
hBasin,
channel
Cubic yards
_
i
I—
t._-
Boat ramp
Boathouse/RoatliR
I
1
I
Beach Bulldozing
Other+-
SAV observed: yes no
r
{
—I--
"'�
t'
�`-
Moratorium n/a yes no
-'
II
wt
Y
Site Photos: ,yes no
-
-_
t
-
-
—,
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
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 N/Money Order Issuing Date Expiration Date

—�2
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: �-VA11 ,,k
Address of Property:
Mailing Address of Owner: ( yy
Owners email: . �a u o 2 OOw` ner's Phone#: _ � \y �{y'1- �p(e �D r°
Agent's Name: ` �Agent Phone#:
W2391?Ra4
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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.
II DO NOT have objections to this proposal. I DO have objections to this proposal.
It you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in w►Iting 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 (Choose only onel
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 r rir r ). (If you wish to waive the setback, you mu i n
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian PropWrty Owner
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: I n `am a7O
\ d i eve i1 Dtr1� N
ARPO'semail: 0aYiAu'idr Q.Qo1.CnwrwRPO'sPhonne#: 3�,0•5?lq • 13y3
Date:
'waiver is valid for up to one year from ARPO's Signature•
Revised August 2022

C:
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 Propei
Address of Pro;
Mailing Addres,,
Owners email:
Agent's Name:.
Agent's Email:,
FIAT @ 40424
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adlacent 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 drawino with dimensions must be provided with this letter.
✓ I DO NOT have objections to this proposal. 1 DO have objections to this proposal,
IT you nave oojecbons 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 (Choose only one)
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 riorap 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
-0R-
Signature of Adjacent Riparian Property Owner
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:
ARPO's email:
Date:
O S v853d
ARPO's Phone#:
*waiver Is valid for up to one year from ARPO's Signature*
Revised August 2022

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