89775A - Drummond, Leon

Ifni)❑CAMA ElDREDGE & FILL NO 89775 (A) B C D
GENERAL PERMIT Previous 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:
15A NCAC ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.goy/CAMArules;
Applicant Name
Address
City State ZIP
Phone # ( )
Email
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 1
Type of Project/ Activity
(Scale: )
fhnralinn I anofh - -
Access Length
Pier (dock) length
Fixed Platform(s)
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Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/q
Bulkhead/ Riprap length
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-
-
r-(
--+
Avg distance offshore
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Breakwater/Sill
Max distance/ length
Basin, channel
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-
Cubic yards
Boat ramp
Boathouse/Boatlik
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Beach Bulldozing
Other
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SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
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A building permit/zoning permit may be required by:
Permit Conditions
❑ TAWPAM/NEUSE/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 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 #/Money Order
Signature
Issuing Date
Expiration Date

ADJACENT RIPARIAN• PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) REC�-+EIV , (F".:
.
Name of Property Owner: 1,eAN , Vf-0.YYI
Address of Property:
Mailing Address of Owner:
Owners email ZPhiu6PC/.y sy-cor+Owners Phone#: ��-
Agents Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
APR 2 0 2023
DCWEC
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
X I DO NOT have objections to this proposal. 1 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 (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 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 l✓fw
Signature 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:
TypedlPrinted name of ARPO: rAI (U+A4L FISH AAdr-10
Mailing Address of ARPO: % %2 s VA/ t PTT Kaa ge 2
ARPO's email: MIAef/lq gytosil corms ARPO's Phone#: 9I+Lz1- gJ(cs
Date: . -Jq- 2O2-3 'waiver is valid for up to one year from ARPO's Signature`
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
(Top portion to be completed by owner or their agent).
Name of Property Owner:
Address of Property:
Mailing Address of Owner: A5 ' Dr %7e� e— z7?5l1L
Owner's email: /Pon, fbwi 5.!v ®m�Cvw,Owner's Phone#: 4 %92 6 24
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
CEIVED
APR 2 8 2023
CM -EC
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.
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 (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 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 of Adjacent Riparian Property Owner
-OR- . �{ r
I DO NOT wish to waive the 15' setback requirement (initial the blank) I 1 ,tom
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO`f—
Mailing Address of ARPO: '��4"� (_ L11I lam/ WKh� l LC ( \`U -L
ARPO's ee ail.�tSC° 3bv`}'wlt�rll'r6 • t4v^ARP0's Phone#: 25 7-
Date: 2 *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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