89161A - Davis, Keith and Nichole

1*"t°"514,kr�EZCAMA ❑ DREDGE & FILL N9 89161 A B C D
GENERAL PERMIT Previous permit
3 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. [A General Permit Rules available at the following link: w ..deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ IDEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no, PNA: yes/do.,
Type of Project/ Activity
(Scale: i )
Access Length
Pier (dock) length
Fixed Platform(s) _
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Floating Platform(s)
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Finger pler(s)'
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Total Platform area MEISSEN
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Groin length/#
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A building permit/zoning permit may be required by: : •^ 1.
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER(circleone)
❑ 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)-I'�-
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

RECEIVED
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS AUG 12 2024
�sDCM-EC
Name of Property owner Applying for Permit: J<,6(i'4 `% {v ICN F
Mailing address: i i 8 L, De 1 t/L
mecty N l LL d Nc) 2-7L45 Z
Telephone Number: TY-762©`1Y-20 12 A - 7&Q 26a
I certify that I have authorized M WN CaiNb D�vl�toPlnl(:,—"agenUcontractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 12 O A Dock
at my property located at 118 AI (f fD 2E De I VE7 Ni —I/ th LL UL,9?4
This certification is valid through , 96g) tar 31 , 202�5 (date).
(Property Owner Information)
Print or Type N me
co. owner or trustee for property
al161AS7- 62 t 21)2.4
Date
q�8•� cJ'1
Telephone Number
ICFt T 11 I�AzI15 QAAL -Z.-CM
Email Address

DECEIVED
x e,, omsioN if COASIAt SAMAWWWT AUG 12 2024
WO"m P*00041tArt
WcVp'T "wit vc ur y OCM-EC
#a. #A rry I-
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RECEIVED
AUG 12 2024
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFiCATIONIWAIVER FORM
GERTi lEC? tRA�t R URN PECEIPT FtEC3UE5TED ortiANp DELIVERY ,)CM -EC
(Top portion to be completed by owner or their agent)
t", 9
Name of Propetty Owner. � , nnt —bE
Address of Prntrarty
"Ming Addre sofowner ..-5
O*.vners ank't.l 13..Gc.. 4�netsPhone#
LGtGMD(ci 6rtRtYtc,e
AgenfsNante, 6wr_1S_1.�it��._I�? t44PrJ Agent Phoneit zS1._yzw_3ta5 .._
Agent's Email: __y�1 •1 i1 .tit ` — �j -. __ __
ADJACENT RIPARIAN (PROPERTY OWNER'S CERTIFICATION
; i ,orza portion to be comotetad by the Adiaeerrt Property Qwner2
I hereby ceriafy that I own property adi9centtotbe above referanta.d propWty. Tne rnxtivrduat appiyinc toy this
peumt has deserrbe4 to me. as shown on the; attached drawing, the devefoprnent they are proposing. A
csrrtgtior qr drawina wtift dirsrfsions must beQrovided utith thi; i0iig[.
f G{) Rol t{ave ut eCions to tiers ftmpasai .. 1 DO have objections to thrS proposal.
_.._ . _ ..�-.._ ,w�,.,_-x...
Pf you Have pkieotions to wlsat is Going proposed, you must DGftfy Noe N.C. t)rvrsian Of Coaszat
R4anagament (DCM) in writing within 90 [lays of rece4pt of Stets notice. Correspondence should be
tnaiiad to dll9 S.:Griffin St., Sea- 300, Elfzatteth City, JVC, 27009. DCLf representatives can also be
contacted at [phone]. No response is considered the same as no otalecflon if you have been
notified by Certified Mail.
W&WER SECTION
I undermand that any proposed fief. dads, rncxrring pilings, boat ramp, breakwater. boathouse, lift, or
groin must he set back a minimcrm distance of 15' from my area ctl riparion access unless waived by me
(thrs does rcot apply to bulkheads ar n0rap (evetments). (if you mesh to waive the setback, yqu must sign
the aWepriate blank beiovr.f
I,',o wish to waive somefairor the 19 setback
3rpnatc+re ta(ArljacerrP f�+t>ar+e,n Arc�ariy Owrrrer
I do not wish ;o waiive the 46 satba::k requirement (initial the blank) _ .--
,Signature ctf Adjacent Rtuanan Property r3wner. _ °f�1I I %F r(r -
TypediPrinted name of ARPO', ,. _. 90,wr
Mailing Address ntARPO- _
ARP©'s email: tZhl 0i, -t tNft+F 4gRPO's Phoned-
Da3et ... $ Z __..,'waive[ is valid for up to one year fromARPO's Signature'
fi'an4rrrti Jtdy 2021

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