89131A - Taylor, A.D. and Sherrill

tdealsq�$CAMA El DREDGE & FILL N9 89131 rA,, -B C D
GENERAL PERMIT Previous permit
Date previous permit issued
t 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 I❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
Authorized Agent
Project Location (County):
State ZIP Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body in an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/fib PNA: yes/no
Type of Project/ Activity
_ (Scale:, a )
Access Length-
Pier(dock)length
Fixed Platform(s)
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A
Floating Platform(s)
A
Finger pier(s)
Total Platform area-
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Groin length/#
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill,
Max distance/length/-
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlik
Beach Bulldozing
Other
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SAV observed: yes no
Moratorium: n/a yes no ;—~
Site Photos: yes no !
Rioarian Waiver Attached: ves 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
IAM 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 backofpermit** Signature'
Application Feels) Check #/Money Order Issuing Date Expiration Date

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RECEIVED
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM APR - 8 2074
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) DCM-EC
Name of Property Owner: fa D 'fak, (o
Address of Property: i$ a CD8A/ l l 64,rc n e a l eloo
Mailing Address of Owner:
Owner's email:
Agent's Name: j2;,dw vha/Irt! x'nc
Agent's Email:
Owner's Phone#: ?Sa- 2 3 D- 3 1 80
Agent Phone#: a $a -331- &313
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.
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
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 revelments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setbaclf/ _ [- _ /, / L - -P. A -70jp-
SJgr lure of Adjacent Riparian Property Owner
-OR- V
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

IRE C DIVED
Agent's Name: IQ�� t 1rP
11
Agent's Email: ICty1"En r: if e
N.C. DIVISION OF COASTAL MANAGEMENT APR - ® 2024
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY l✓M �+nn—EC
(Top portion to be completed by owner or their agent)
Name of Property Owner: A �CLrN le/ r7
Address of Property: fdQCA ,-kI'1014Aa- RD Ck {AIL a [110
Mailing Address of Owner:
Owner's email: i7 Owner's Phone#: a.Sa- 2302- 3��6
Agent Phone#: ,Sri 3,31 - 03 t?
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
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 ff 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 sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback NLv� /gg4w�
Signature of Adja nt RiparianProperty Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian
Typed/Printed name of ARPO: _
Mailing Address of ARPO: Is
ARPO's
Date:
Owner:
PhAe#: �S� >�' ad 5
`waiver Is valid for up to one year from ARPO's Signature'
Revised July 2021

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