89155A - Wynns, Leo

eo+ comr"N❑CAMA ❑ DREDGE & FILL ND 89155 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. ❑ General Permit Rules available at the following link: wwwdgq.nc.gov/CAMAruIes
Applicant Name _
Address
City
Phone # ( )
Email
i
Affected ❑ CW ❑ E W ❑ PTA ❑ ES ❑ PTs
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no. PNA: yes/no
Type of Project/ Activity
ck—li— I..e k
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body (nat/man/unk)
Closest Mal. Wtr. Body
(Scale: )
Access Length
Pier (dock) length
Fixed Platform(s)
Eli
Floating Platform(s)
1011
MEN
no
ME
No
Total Platform area
M
NMI
■.■■:E
Bulkhead/LR!prap length
Bulldozing"
8:M
:
:
®■■
■■■■�
H
■■■■■■
■■■■■■■■■■
■
:N�
C■:
■o■�.■.■■■■■S..■■
®�u:�n
:
N
N
M
ME
:.
■
:
::::
::
■■:Beach
''
IN
SAV observed:
Morat
Site Ph otos: yes no
Waiver Attached: yes ;no
■N■■:p■
■■■■■■■■
■::■
.p::■.:::�::■:■:■�:■�:::■N■
.:.IN�0■
Ming
■■■
MEMORiparian
■�
:
A building permit/zoning permit maybe required by:
Permit Conditions
❑ TARIPAM/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
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature
Issuing Date
Expiration Date

Docusign Envelope ID: 9ABC4A4E-01F1-4493-96OD-4l FllADF9269
N.C. DIVISION OF COASTAL MANAGEMENT „DECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONWAIVER FOR
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY JUL 2 9 2024
(Top portion to be completed by owner or their agent)
L4,1 W,4.nr.5 i _
Name of Property Owner.
Address of Property:
Mailing Address
owner's email.
fAeas 4 iN
ran, Owner's Phone#:t-
Agent's Name: C v' 4 ` -- `"` Agent Phone#: -,Z r• Z 1- 4�f
Agent's Email: C n
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacant Propa Owner)
DCM-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
(fib I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposes, you must noury me rv.L.. miviwvn u, a v--
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 &Lose 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 riorap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive someiall 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: R61-Ag-
TypedlPrinted name of ARPO: Ovr• kC.- P O r • c (e
Mailing Address of ARPO: QJ d uy 29 ejf ery,`ni All- L74 2,y
ARPO's email: �#Aeallt!j D-gv Se all. "0% ARPO's Phone#: Lrt. 3LS 900.11
7/28/2024
Date:. 'waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

Docusign Envelope ID: 9ABC4A4E-01F1-4493-960D-41F11ADF9269
l
11
Y
0
O
II,
w
m
d
Il

N.C. DIVISION OF COASTAL MANAGEMEN I
ADJACENT RI ARiAN PROPEERTY OWNER NOTIFICATIONANAIV
CERTIFIED MAIL • RETURN—F ECEIPT REQUESTED.or HAND DE
(Top portion to be cc impleted by owner or',their agent)
Leo „hs
�L - ,. ty
of Property Owner:
6teral�
;s of Property: r—
3 Address of Owne ; D tdJ Irb)
'f7Nttees'P ,
�s email: /G{i' • �� � i er's hone#:
's Name: ( Agent Phone#: Z
's Email: _
REC EVE®
FORM
ERY jpL i n 2024
DC -EC,
ADJi�CENT RIPARIAN P ROPER17Y OWNER'S CERTIFICATION
Bottorrhh I o be co a he Ad ent!Pro a Ownet
idei
rtify that I own roperty adjacent tathe above referenced property. The individual applying for tt
described to e, as shown on toe attached drawing, the development they are proposing.
o rawin th dime ions rovided i t i Ie$er.
I DO NOT ha a objections to this broposal. I DO have objections to his proposal.
Ive objection to what is being proposed, you must notHy the N.C. D vislon of Coss
Man 'gement (DCM) in riting within 10 c ays of receipt of this notice. Correspo Bence should
main d to 401 S. 1! r St, Ste. 300, Efiz abeth City, NC, 27909, DCM representatives .can also
- 9 contacted at (252) 25 01. No responseIs considered the same as no objactio if you have be
notified by Certified Mail
WAIVERSECTION
(Choose only one)
;
I understand
groin
this
that any proposed
must be set back a
oes not aDDIv to bulkheads
pier, dock, n
minimum distance
or ri rarevetments
ooring pilings, boat ramp; breakwater, bo
f 15' from my area of dparlan access, unle
). (if you wish to, waive the setba
douse, lift, or
s waived by me
k, you must Sig
propriate blank be
ow.)
the a
I DO
wish to waive some
fall of the 15' setba
k
V Owner
Signature of Adjacent Riparian Propei
-OR-
I DO
NOT wish to waive
the 15' setback req
iirement (initial the blank);
re of Adjacent rparian Property wneifa
r• " tii<ti2
hme inted nao ,ARPO: 5 1PrM d el
Address ofARPO: 142- a Wtn 'iuWr�-
email: ARPO's Phone#;Al ' `t
aD 'waiver is v lid for up to one year from ARPO's Signature'
Revh ad August 26
r

E
0
0)
M
O
66
N
O
N
ifi
N
af
u
ul
O
N
C
N
7
w

1 r
y-:
-x.
I�
i �
`_`
'�
/..
'
..
_
'.�
��
Ig �� i't
f
R
>_
�,
7
Y-4z
r
`
i
,n
� �� .
t
i r

Q
III

<z
'ter`
a
I ,
Y \
1 � 1
CD
co