92698A - Rountree, Margaret

dtea°", P6AMA ❑ DREDGE & FILL
1121), GENERAL PERMIT
Dilw ❑Modification ❑Complete Reissue ❑ Partial Reissue
N9 92698 CW B C D
Previous permit Al/4
Date previous permit Issued J4"
As mthorized by the Sate of North Carolina, Department of Environmental Quality and the Coastal Resanms Commission In an area of erui onmemal concern pursuant to
ISANCAC 07f1. 190D
]Ruies,maded.
G&wral Permit Rules are�llayble�k: at the W&Mng Rn�ww+.dm.nc.aov/CAMArules
Applicant Name w,49,i -s?�V
A/AN7"T.ZJe�
�
Authorized Agents •�--
Add. 277 ZAKfK �-90?'
�F.D�LI%
l��rrmemo
Project Laradpn (County): _
Cay state
14• e•
ZIP g7 93 `d'
street Acidress/Sate Road/t.ot #(s) LaLr-all: /l -
Phone#g.'�Z3/2-,5'/�/
[ E/S tar gib S/ypag--Xad
Email i.•+D�rean'� A
O a -/
GoM
subdhision L91611A er S6AORK15
OW eP,440 zip 2 7 g/ 4r
ARetted CW atV
.�7A
Es F1 pTS
Act. Vft Body /� lam/ ttnryunk)
AEC(s): n OEA IHA
❑UW
E]SPIMA PWS
Closest M4.Wtr. Body e_ "A- l �IVd'K
ORW: yes® PNA: no
Type of Project/Activity, J � z ,.lt x 4 ' he ,::, E !;F71aV- 16 :r
�UaZa� (Scale: n(r'R )
Access Length'
Pier(dock)1er0h /lt,'
Fixed Platforms)
,
z
Floating Platforms)
Finger pier(s)
Total Platform area-
Gminlength/#
l
,.
_ru
2.
_
Bulkhead/Riprap length
Avg distanceoffshore-r-
-�--
--.
-
__
_.
.
-
_.._
.J
BreakaaterMl
I
-
Max distance/ length
-'
Basin,channel
cubic yards
Boat ramp
-
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r
-
N
-r
-
--
-
-
-
—
-
--
-
-
1
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—
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it
%
-
—
-lr..
-
Boemouse/ Boat#h
Beach Bulldozing
omen
SAV observed: yes n
Moratorium: n/a yes
Site Photos: yes
Riparian Walker Attached: yes nq
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AbuildingperrNt/mningpermitmaybereyuiredby:Ro�gO l rd+'r+
Permit Condtdom / �a '• a�ar.l 1 it wSr ss.j GGs^-tOL/Atd aE' ❑ TAR/PAMMEUSE/BUP}�t(cirde me)
P/ I ]d. /SA 4CAe 079 El See note on bark regarding River Basin rules
See additional notes/conditons on back
I AM AWARE OF 51AITUTES, CRC RULES AND CONDITIONS MAT APPLY TO THIS PROJECT AND REVIEWED COMPUANCE STATEMENT. (Please lnitlaq
>< MJk0.CrMFT (awaNT4�t
Agen or AppllamPR RED me tt Is PRINTE Jarr(e
x it �-.
s mure••P asereadcor p tans ant on back ofpermk•• Signature ,�J
.�ao
pA placation Fee(s) Check#/Money Order Nng Date Expiration Date

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Imo✓ C:AMA ElDREDGE & FILL N9 92698 � B C D
Previous permit A/GENERAL PERMIT Date previous permit issued ke ❑ 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 4'"7 // • /-70 ❑ Rules attached. general Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name h✓4g4A-RFT' 'e�7 rD!?l�'r"R L�6
d re277 CA14 GocP lam. ,,A-O
City fq s r /LSE State 14- G . zip " 7 93 8
Phone # (?,527 3/2 //— 5/ if/
Email M G(PO4n"r'/ r..e (dfp e ad I . Ga M
Authorized Agent ��7FYFF T"47A V/S L/LLC 4f
Project Location (County):
Street Address/State Road/Lot#(s) L4rr--04
LEiSvRe .5wo2E�2ai.
Subdivision I-V-60RC .S469?fS
City 'eDM0 zip ? 7 V 4'
Affected ❑cW
�
PTA
❑ES
❑PTS
Adj.Wtr. Body M,0W
.Zj914 man/unk)
AEC(s): ❑ OEA
❑ IHA
❑ DW
❑ SPIMA
❑ PWS
Closest Maj. Wtr. Body
GffoA/'.ATt �f/ t'YL
ORW: ye no PNA: yesno
Type of Project/ Activity J/o [a'(4 x
�G/7 7�oldN+ (Scale:
Shoreline Length
Access Length�'�'
Pier (dock) length / /o ^
Fixed Platform(s)
/b x / 6 / Y v ! I
Floating Platform(s)
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 _
Beach Bulldozing 4/ cse r—% 'P
i
Other QR»y c.
SAV observed: yes no
Moratorium: n/a yes
Site Photos: yes no
Riparian Waiver Attached: yes n
A building permit/zoning permit may be required
Permit Conditions Zs ds-r7 '+ eT,7o `l
Pli-7--t isA 61eae o�2�/ . /200
Agent or Applicant PRINTED Name
X
Signature **Please read compliance statement on back of permit"
and L�IC � �66% 4,WW�/7e>7
fpphcation Fee(s) Check #/Money Order
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please
CCU
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suin� Expiration Date

#F]New
❑LAMA [IDREDGE & FILL N9 92698 C_� B C D
Previous ermit A/GENERAL PERMIT Datepreiouspermitissued ❑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: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City _
Affected ❑ cW ❑ EW ❑PTA ❑ ES ❑ p-rS Adj. WI Body (nat/man/unk)
AEC(s): ❑ IDEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. WI Body
ORW: yes/nor PNA: yes/,ho)
Type of Project/ Activity �.:� �i -� 1: - - L� E >'--i 1 , i
(Scale: )
Access Length
Pier (dock) length
Fixed Platform(s)
A,
-
!_-
T-
L
Floating Platform(s)
4
`i
-
Finger pier(s)
I--
Total Platform area
Groin length/k
Bulkhead/Riprap length
Avg distance offshore
—
-
-------
----F--
-- --
-
-
-
�"
—
I-
--
-�A
L__---
--
-
_--
Breakwater/Sill
Max distance/length
--
-
-
Basin, channel_
Cubicyards
Boat ramp
Boathouse/ Boatlift
r
J
LI
J-'
ra
V
�-
/:
6
-•
-_/
-_
-
r!
i
Beach Bulldozing
Other
SAV observed: yes no
—
Moratorium: n/a yes no r i-
i
Site Photos: yes no
-
1
!
Rioarian Waiver Attached: ves 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. (Please Initial) X
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name i
Signature**Please read compliance statement on back of permit'* Signature
Application Feels) Check p/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: M 0ra ro�'r t-QLW Te-t V
Mailing Address:
Phone Number:
Email Address:
33'1 C,AF-'TE'R Loop FD'
Crl \j-t v�, VI, Q f- �-i Ct
yvxdvoLAA tee @ 5vnait. coyo
I certify that I have authorized ✓l S t,l t, U C%j
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _t Y
at my property located at 1,01' " LEA Suv E svt-ov-S FD •
in County.
1 furthermore certify that 1 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:
Rt�lll�
Sign ture
M,l�p.t� t`outJ'Ct��
Print or Type Name
Tide
Date
This certification is valid through

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: M'h NL-"1'-�-T SLoNNTt,� E
Address of Property: tOT fit\ Lie S Ha P-e P D c6NA
Mailing Address of Owner: 131 cAV TE4- mop "- (A-1US\lt-LIF1Wc 121'1i2>
Owners email:r\v okn'rY`P,t 0—SwAil coNi Owner's Phone#: 25ti"317 �141
Agent's Name:
Agent's Email:
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
oermit has described to me, as shown on the attached drawing, the development they are proposing. 9
1 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. Dtvislon of Coastal
Management (DCM) fn writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Grim 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 slpn
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
S73
I do not wish to waive the 15' setback requirement (Initial the blank)
Signature of Adjacent Riparian Property Owner:
TypedfPrinted name of ARPO: T- QO-UkU U 7WY A n X "r 1 n r
Mailing Address of ARPO: 12,25 W N00&k W S od VA NX v'r
ARPO'semal: RAc�. L SVyKZ � ARPO'sPhone#: "ISl f�3-1 2-Cp2A
Date: 3 `Waiver Is valid for up to one year from ARPO's Signature"
Revised July 2021

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: _ I'A A Ry 57 (r-O uN Tt1 E e
Address of Property: V°T 4V 11 I,el Sub E Stt0J%,S p-0• WMo, Q u 7--1 2> 1 J!�
Mailing Address of Owner: 331 c, Af-� t.00p 9-n. e-A-TesA"-E . N c i-'tg3 b
Owner's email: Mdyouvlcyee () ayAcdk- cD� Owner's Phone#: ybti- 3tz-y 14-1
Agents Name:
Agent's Email:
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
description or drawing with dimensions must be provided with this letter.
04 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 nary me rcu. urvrsron or t:oasrar
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 sion
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
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:dL" Lr/r67[�YrY
Typed/Printed name ofARPO: JZ�bec�A r 14A ►'f !�
Mailing Address of ARPO: r�uee� �h'&?44 e*me� �C
rn
ARPO's email: hmfirXUk-'4- 1600999' h II A' RPO's Phone#: !�Zs �,2
Date: l] 3 ' �� 27 'waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

NC Division of Coastal Management 25759c n
Cashier's Official Receipt
n Date: 20
Received From:
Permit No.: 0.2-1, q/-%�_ _ Check No.: -7 a
Applicant's Name. . �� 4'� � '°�LdET County:
Project Address: /��'�
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date:
Signature of Field Representativ • Date: oz`