89128A - Jarvis, William and Constance

of murgr ❑CAMA EDGE & FILL N� 89128 ;"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:
I SA NCAC r' \ \ {.: ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deo nc gov/CAMArules
Applicant Name L`r•(1\s I.'•:.:,',1�. r•,+_t \D..I,':.
Address I lout:,
City State ZIP :,l -I q
Phone #(3LL) !c t14 `'9 'rJ'"i
Email .)<drvr to Pe,.i vr,i 4,.k'I:+�.
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Affected ❑ CW ❑ E W ❑ PTA ❑ ES PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yewkl PNA: yes/no
Type of Project/ Activity
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
1....
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body i
(Scale
Access Length
Fier(dock)length %
Plam tfors)
Fixedxed Platform(s)
41
-
�
�C
{
j
;
Y
1
__
7
(-
-'
—
r-
\
t '
IL• \
!
Floating Platform(s)
I—
i
I t
KJ
_
v
_
Finger ier s
i
e
Total Platform area
Groin length/#
Bulkhead/ Ri P ra length .�'
P gt
i
---
.
!P'
i—'
' `
.)
I,
�—
,--
-!
Avgdistance offshore �
I,
-- �
Breakwater/Sill
Max distance/ length +rcl
?
�1YWW,I
77
-
Basin, channel
Y
.,"'_•
Cubic yardsBoat
ramp
�
st
_
Boathouse/ Boatlift
t,6
'
, .
Beach Bulldozing
M__
s.
`.
Other l
'l
-
s—.�••-
su
b,r
'1+._
i
-
—
�h.
_
-1t
c�
SAV observed: yes no--}—
-
--
:
—
-
Moratorium (n/a' yes no
-''[
--
—
T
-tf f
t3 ��
jTf_i
s
Z •
i
-!
Site Photos. yes noI�
_
i
_
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Riparian Waiver Attached: yes 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
_„{.
AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) is '�) /-•'L-
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature**Please read compliance statement on back of permit** Signature
Application Feels
Check q/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: I.L.: (1 iOL&\ __�•
Mailing Address: IG Lf 12!d2g*- n
Ct-cry► ciar, �G�-/ XM PI(
Phone Number:Ad
Email Address: /� �
t�u�
1 certify that I have authorized d&i "rt?v—,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at myproperty located at Icy cy-ape'-- C < <'aMdae-' '-qG+
in Mtrl-ery County.
I furthermore certify that I 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: ?,y,,,•
Signature
Print of Type Name
Title
Date
This certification is valid through l ( I 1`e I DIV

N.C. DIVISION OF COASTAL MANAGEMENT 4, ;, L- � ``
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY APR 2 5 2024
(Top portion to be completed by owner or t Je agent)
Name of Property Owner: xdy ill *ln/n / 7 ' �J R✓)J a , tt.,'
Address of Property: /P7 t� aV�
Mailing Address of Owner: C, �� 7 L
Tmail s b„ ����,� i��� , r� �a 6 �l� ys✓9
Owner's email: � Owner's Phone#:
Agent's Name: =ldP % l-I'M e ZIC Agent Phone#:a $r3-3. ) - 10,
Agent's Email:
A
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
1 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.
Y 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
malted 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 set k, you must sign
the appropriate blank below.)
1 DO wish to waive somelall 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:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

C)
REGE ED
APR 2 5 2024
US

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:
Address of Property:
Mailing Address of Owner.
Owner's email: ll /rjrJ
Agent's Name: �7
Agent's Email: �G
Owner's Phone#:
Agent Phone#:d,5d-331- (-,313
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
APR 2 5 2024
ITi
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.
✓ I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposea, you must nonry me rv.�. �,vtoly . . ��a�•o
Management (DCMJ in writing within 10 days of receipt of this notice. Correspondence should be
malted 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 slgn
the appropriate blank below.)
I DO wish to waive some/all of the 15' setbacl A,C E
i ature of cent ipanan Property Ownee
-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:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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