89202A - F&R Family Holdings

DREDGE & FILL N9 89202 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑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:
ISA NCAC P")'1fi I I n c ❑ Rules attached.
Applicant
1..
Address
City State t,) C, ZIP • )p
Phone # (2a ) <i 3 5 ' 6 3 7,
Email t,r C( i r>v�. 2- rU Pw
❑ General Permit Rules available at the following link:y8My.deq nc gov/CAMArules
Authorized Agent dS o,.t v. c ( r, V. { i- I t i
Project Location (County): (' r, t r i
Street Address/State Road/Lot #(s) 1 r„+ .4
Subdivision
City .. ZIP
Affected ❑ cW REW 5PTA OES EPTS Adj. Wtr. Body�(nat�man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ OW ❑ SPIMA ❑ PWS Closest Mal. Won Body b�l
ORW: yes/no; PNA: ye no
Type of Project/ Activity 9. cu k cd <: (.. a k •} ; ,.f. o i k> i k �f
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.. vuuuirlis Ir n /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) _j
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 Dale

AGENT AUTHORIZATION FORM FOR PERMIT APPL C TtONS
hlsrne of Property Owner Applying for Permit: 1 4 r!�
f1m..(� f �� d i he
Mailing address: 2-0 604 29 —�� Vyies
Telephone Plumber: J){�ct ®r borne zg 215�
I certify that i have authorized ajgm$��
Y17t (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of E t 1mda
at my property located ate t--Mj is r-ep—r=
This certification is valid through
(Property Owner information)
i
RAMONA L. HUMPHRIES
Prim or Type Name
RAMONA L. HUMPHRIES
Titfs, co. owner or trustee for property
DaEe
(232; 435-6376 (work) - [phone] (home)
Telephone Number
—in ter iors-ramon-2 mbar ma'] com
Email Address
(date).

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
Address of Proper
Mailing Address of Owner SV t�lAt. �r—i (np j(5 ry7(��
,
Owner's email:,Owne's Phone#:3037
Agent's NameOr�Yy1�rsI
Agent Phone#r2521 f2U-3U615
Agent's Email: Q&C-kx f•
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
descn tion drawin with dimension 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 fs being proposed, you must notify the N.C. Division of Coastal
Management (DCN) in writing within 10 days of receipt of tills 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 n objection if you have been
notified by Certified Mall.
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
-OR-
SignatAwScOm R1 man PTqpofty Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Properly Owner:
Typed/Printed name of ARPO: _ffl - gj
Mailing Address of ARPO: u�v(*yVAi n LoAi(',
ARPO'semail:
bU%y��it�l�(aQkYYiil•�YlRpO'sPhone#: `l$�I $))_(gt,{I.�
Date: �/ a '— Valid for up to one year from ARPO'a 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: F&R Family Holdings LLC Ramona Humphries
Address of Property: 1541 Tulls Creek Rd Moyock NC 27958
Mailing Address of Owner: P.O Box 39 Moyock NC 27959
Owner's email: interiors-ramona@embargmabWff&.s Phone#: [phone]
Agent's Name: Browns Land Developing Agent Phone#: [phone]
Agent's Email: [e-mail]
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 forthis
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.
x I DO NOT have objections to this proposal. I DO have objections to this proposal,
it 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 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
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: I A /
Typed/Printed name of ARPO: NC DOT,
Lms, Division Env. Officer
Mailing Address of ARPO: 113 Airport Dr., Edenton, NC 27932
ARPO's email: pcwi11iams2&ncdot.gov ARPO's Phone#: [phone]
Date: 7/ 17/2024
*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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