89075A - Ulsh, Karen

aycourt,N❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N° 89075 A 1 B C D
Previous permit
Date previous permit issued
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 r)-1 M i 1 7 ❑ Rules attached.
Applicant Name k_�,7c r"rt t I i _`,(,
Address 12 W" 1-1 .r 1) .� " I-, C I P'
city W. 1A,=.--t rI -• State VA zip
,Phone # (- i) /_ :% i ( ) {-1
it j
Email �'_<lr N'l1 rll.`i� I�JO Mn -,` rll LYt
0 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Authorized Agent f i k tr u) 1:, k V yv, c:i t-..,
Project Location (County): (_ f 1 r I- I i-� I r- t'
Street Address/State Road/Lot #(s) < C ...(� � 1't-, e' I ( '=r,
Subdivision !'>PI I `i I't-,)O itd
city ('It<r�4-uCIn zip'Z
Affected ❑ CW L'J E W ❑'' PTA ❑ ES ❑ PTS Adj. Wtr. Body C',:I rn I C5 r i 9 <z. J (Raman/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PINS Closest Maj. Wtr. Body CI C(t-hL-I:' -K-,J Yf<A
ORIN: yes/r i PNA: yes/Ko
Type of Project/ Activity 12rs , V 12
(Scale:) s20 j
Chnrnnnn : nn k 1,­,
Access Length /
_
Pier (dock) length
T
-
Fixed Platform(s)0—
Floating Platform(s)
_
L
`r
IkJ
�Iff
Finger pier(s)
Total Platform area
Groin length/R
Bulkhead/ Riprap length
T_
-
_
-
--
-
i-
Avg distance offshore
Breakwater/Sill It
Max
Basin,'channeilength
Cubic
rr"e
'�.-�
yards
Boat ramp
Boathouse/BoatlifT2..c;
/�;n
Beach Bulldozing
!
c
1
Other
L
L
SAV observed yesu
Moratorium '`n/a) yes no
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-
-
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-
-
k6.
-
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00
J
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Site Photos (yes no
Riparian Waiver Attached: des) no
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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 lnitial)V �)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit --
Application Feels) Check ft/Money Order
Signature i
Issuing Date Expiration Date

I Q%JKILAI-ION FOR CAMA PERMIT APPL(CAT(ON
Name of Property Owner Requesting Permit: Virty-ol WLF
Mailing Address: G3 �) 0
Ue-Ie-n Cove
A t�ect c h �Vra d��� ri-
Phone Number: rJ — (a l� l - 4 (I
Email Address: �
' I certify that I have authorized
a4G,e-tJ 5 hem M a q
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: T30Cl+ i t�
at my property located at p�P I Icygl
in CUv`V'h`iUr County.
I furthermore certify that t-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 tangs in connection with evaluating information related to this
permit application.
Property Owner Information:
K

N.C. DPASiON OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIOWWAIVER FORM
CERTIFIED MAID Rt TURN RECEIPT REGiUESTEP or U6UD Q9 )T.0y
(Top portign to be completed by owner or their agent)
Name of Property Owner
^1 it Q. t7 td J . ul !q k)
Address of Property, i i Jli �7/
Mailing Address of Owner. 1 n a� O`�Q U� r� G � A "C
�� (© I -7 t
Owner's email: �Cl r /eft j? i 1 G �CC+ 1 llrj�rs Phone6: L'
Agent's Name: h Q i he..W S r i e ro h G n Agent PhoneJt 5 I �
Agents E marl I1 a icJ� A - �� iUo . Co y�
ADJACENT RIPARIAN PROPERTY OWNERS CERTIFICATION
tBottom ooRign to be comg1ft l by the Adiacent Prooerttl Ovmer?
1 hereby certify that I own property adjacent to the above referenced Property. The in&pMual apphMg for this
Permit has desaibed to me, -as shown on the attacheddrawing, the devetoPment they are proposing- A
®escrlMinr, or drawing witlr dimensions must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal
"Ve- eciSavrs to what Is belt propose4 You must notify the N. Dtvlsron of Coastal
eetl4' jDCAQ 0 writing withh; 90 days of tecefpt of thfs notice. Co pondenioe should be
isrsi/eat'to'4ttt M Of ifimSt., Ste. 30, Elizabeth City. NQ, 27909 'DCaI rePresenlatiwas can also be
i66#hwted at (2 ) _ No response is considered the some as no o6JecSon if you haw been
0&dby0erffedMa1L
WAIVER SECTION
p #Adt3 tbaf any,proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, M or
j0 to ef:bac)s,a min"anum distance of 16 from my area of riparian access unless waived by me
1 d rjot plrly to bulkheads or riprap revebnents). (if you wish to waive the setback, you tmtrst sign
wapprc►ptiatetdsrrk'
t /
► S tonrarire om"toithe 1 taac v�t,,_ �✓� �;;
Signatum fAdJacentl phrfenPmpertyOwrher
y� !v
"tULM,it £i
�0
{initial the btiank) �.
.L

N.C. DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWA1VER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed` by��owner or their agent)
Name of Property Owner i`-t%�/t J, lit CJ� "1
Address of Property- gag r+').l..l..i ,5 jA �Clt-i � n 5 a
Mailing Address of Owner i Al t.o H e'k J 817 CU V 2 V0
Owner s mail: n_ �J"YP`j 1. U (5�%!� �' CIP01 1- 6 8wnees Phone# I J 7 � � -) o
Agent's Name: / �.{ aJ5 o 1� Cl�,j 1r1C Agent Phonetk A 5 43
Agent's Email: %1tP(fi2am (5l= C'0UJ (a''k
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owned
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
desgEi Lbon 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 (DCflfj in writing ► Min 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. G "Minn St., Ste 300, Elizabeth City, NC, 27909. DCM repmento ves can also be
contacted at (232) 264-"01. No response is considered the same as no objection N you have been
notified by Certified Mail
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, ldt, or
groin must be set back a minimum distance of 1 V 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.)
DO wish to waive somelall of the 16 setback
Signature of Adjacent tdipanian Property Owner
I ItP Waif Wish tb waive tits 15 setback requirement (initial the blank)
Signatt of Adlaoerlt Riparian Property Owner,
f �/

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