89064A - Mathews, Elliott and Charlene

��: CAMA El DREDGE & FILL N9 89064 A B C D
. GENERAL PERMIT Previous permit f�
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: wwwdeo nc gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Email Subdivision
City ZIP
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
(Scale: )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no r
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no I it
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"
Application Feels) Check g/Money Order
Signature
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
Name of Property Owner: 04p `S Ala
Address of Property:
Mailing Address of Owner,
Owner's email: «toi{r1aY ler trt*_,`fto
Agent's Name:
Agent's Email:
by owner or their agent)
>; ni—
Ar/)
kc
RUC )7`13a
ner'S hone#: 307 —3& j " 7 97-3
Agent Phone#:
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.
xI 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 sfan
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
no
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
M
Mailing Address of ARPO 104+ E. o0VCWX1> 'P& P1A11 M 9K A
ARPO's email: r4I1bV4PPk&fI`ICd dW ARPO's Phone#: fp7" 707.-1,Z jp
Date: 3 z " O' "waiver is valid for up to one year from ARPO's Signature'
RECEIVED Revised July 2021
j U N 10 2024
DCM-EC

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion! to be coml
Name of Property Owner:( �r©J
Address of Property: l I /ifr
Mailing Address of Owner.
Owner's email:P��,a}i Mutr�° 5ro{
Agent's Name:
Agent's Email:
e�te/df by owner or their agent)
7� t t' ,)s i--
N�'
Phone#: r/ `36/ - Y q 73
Agent
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
I 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. otwsion or coastal
Management fDCM) 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). (It yoy wish to waive the setback, you must sian
the appropriate blank below.) 7.11
/
I DO wish to waive sometall of the 15' setback J(/J // 1 116-1/
Signatu of A )acent Riparian 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: �5,lgvG duty
Mailing Address of ARPO: 171 10A Nr � f%
ARPO's email: ARPO's Phone#: 20z
Date: 0 1A10 *waiver is valid for up to one year from ARPO's Signature'
RECEIVED
J U N 1 0 2024
Revised July 2021
0CM-EC

RECEIVED
gg
JU++N 1 0 M4
OCM-EC

d
vi
ad
�
4
S"
M
lit
9

A
. y
t�
r
'r �