89118A - Jagucki, Ted

�oaOcomrar ❑CAMA ❑ DREDGE & FILL NO 89118 t. A ..B C D
a 4. GENERAL PERMIT Previous permit
30 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:
I SA NCAC ' s--) - I i' e° r ❑ Rules attached. ❑" General Permit Rules available at the following link: www.deq.ncgoy/CAMArules
Applicant Name i [ c" Il r " q ) !'„ IS.:.. t. Authorized Agent
Address t : Y. i - Project Location (County): C� UV r 1 `V '.
City State ZIP Street Address/State Road/Lot #(s)
Phone # (.)
Email
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PITS Adj. Wtr. Body Cat to rz.) +C, D O ttkA cI r, -ts4 (nat/,mari/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body C J Y t, t U <- �- 0 t.A-y1.8
ORW: yes/no PNA: yes/no
Type of Project/ Activity c-A it
r
(Scale: t - 20 )
Access Length
Pier(dock)lengthFixed
t--
Platforms)
Floating Platforms)
-
`
T
I
Finger piers)
�
�
_
_
_
�
i _
,I
i
-
Total Platform area
Groin length/k
1
r
�_._(
,ii'J
-
Bulkhead/ Riprap length,
Avg distance offshore
�-
1'"r
t�
—
I
,
Breakwater/Sill
-
-
-�
-
�~i "'
"�
'"
Max distance/length : 1
i
L
t"'
-
-
Basin, channel
_
f �
__i.
_ -
Cubic yards
Boat ramp
Boathouse/Boatlift
`
LL
. C
Beach Bulldozing
Other
7
- r-
SAV observed: yes no
1
-
t
-f-
-
4
I
Moratorium:.n/a yes no
Site Photos: no=-
yes
RiparianWaiverAttached: Yes no
A building permit/zoning permit may be required by: t't.4 -
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**Pleas read compliance statement on back of permit** Signature
ar, / 1 ,:.
•�'-�i( r....- I tici - l'? iCl -
Application Feels) Check N/Money Order Issuing Date Expiration Date

in-�'O.IS
4.C, OMSION OF COASTAL MANAGEMEh
JACENT RIPARIAN PROPERTY OWNER NOTjpjCATI0Nl444_ F
°�b1 73�Ic3J AASaIf • l3ETURN Rr-f r-lo-r AVER ®�
i 1 OP PPoorroon % be C®rripleted by over or their ace-np
Mane of properir (7uuner: _ I PA [ 1 na .nV
Address of properly:
Mailing Address of ow
owners errrvtt , 4',<d <ac Owner's p
yy��v,,����� �� v � p t'on�
�tgenfsame:lddll_t'Ll S + i-F 1 ' Aaent Pn�� 1 �QQ _M Q
oent's
ADJACENT RWARIAN pkepERTy OWNEWS m TIE -IC :' irk
x9ttPHn noon *w t a .:...ves_ a c_ _ ... _ __
RECEIVED
j U N 2 4 2024
DCM-EC
l herebycer%f illat i Own propertyadjaceritto the aboverefereneed property. The individual appiyingforthis
permit has described to me, as shown on the attached drawing, the development.. they are proposing.
ciggedoton of drawinu. with dimensinviq mmf he
NOT" have objections to this proposay. f DO have objections to this proposal.
W yore have ab ectlpm to what is Reins pr®R�d. F/aae saaLWto6ft,, Lire NX . DA4SP®n Of U�skai
r+�nagemenk (Dc" !n bvrllyng within 90 days Of veceipf of this rioRce. Coff empondenoe should be
died lo, 401 & GrWh W, ft 3w, m&ab9f6 Cdb'y. Ale 2 g. 0CM eel ms-entsoves can also be
gmdacted at (2) 2P44WP. Ab mponse is consldomd the sal* ae nv e4fcpv@ols !f you have bevT
€oohed by Cadffied WK
WAIVER SECTION (CbGOse only aneB
I undeleiand.that any proposed pier, duct:, mooring pilings, boat ramp, brealomate;, boathouse, Eft, or
groin must be set back a minimum distance of I T from my area of riparian access unless waived by me
(this does not aonty to bulkheads or JaM revetmentsl. (if you wish to Itieve the setback„ you muss slaw
the approplate blank below.)
100 vAsh to waive someyall of the 95' setba
4 SIgnafuire ofAdjeo-vgt Ripanan P opeffy owner
I MOOT Lavish to waive the t & setback requirement (initiai the blank} ! `"
» -.. set'
Mailing Address bin ARPO'
[A�FFO�J
Date:
ARPO'B Phones
9'10
Is valid for up to one year fvom faRpe`c, 519nature'
Revised August 2022

6/26124, 8:48 AM
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Your item was delivered to an individual at the address at 12:39 pm on June 21, 2024 in MIDLOTHIAN,
VA 23114.
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June 21, 2024, 12:39 pm
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