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Home My WebLink About89217A - Bittner, Patricia0 LOM1°'tyl ❑CAMA ❑ DREDGE & FILL NU 89217 A B C D GENERAL PERMIT Previous permit I 3 Date previous permit issued �I 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 ❑ Rules attached. General Permit Rules available at the following link: wwwdeq nc ¢ov/CAMArules Applicant Name City Phone # Email Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Affected ❑ CW Q EW 0 PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no PNA: yes/no, Type of Project/ Activity 75 r-, (Scale:;' ) Chnralina I anor6 Access Length Pier (dock) length Fixed Platform(s) NJ Finger pler(s)' 'C■■ ::�: :::::MKim Total Platform area ■. ME SEEMS I. ® ■■■■■.M■■O■ .. ■■■■■■■■■■..I�■�.'' ' C. 'Elm 11 C0.■'®■. �C:GO11111 ■■■■■ INNo �r Fo gg i�inl rl■■■� ■■ ■■ MIN ME ■■Ion �■I/ ■■�;■■■■■■■■ "' Moratorium: n/a yes no yes no Site Photos: Waiver Attached: yes no a ERE ■ ■■■■■■■■ ■■■■■■�■■■ p �■ ■■■■■�: ■ ■ ■■ ■Riparian ■■ SO A building permit/zoning permit may be required by: t C r , , `,L, 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 THATAPPLY 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 back of permit** Signature Application Fee(s) Check#/Money Order Issuing Date Expiration Date ■ Complete Items 1, 2, and 3. ■ Print your name and address on the reverse A. Sign ur so that we can return the card to you, X ■ Attach this card to the back of the mailpiece, _ rC or on the front ifsP ace permitsS• Received by (printed Name) . S &-kr Sam �gAIL a-P 4/n el-: C w 1a35 M. Loop w s+e a0S NO(O-161-1 Tx '1 ploo r IIIIIIIII IIII IIIIIIIII IIII i II II III II III IIII III 9590 9402 8750 3310 1137 69 7022 2410 0002 n1370ah9460 PS Form 3811, July 2020 PSN 7530.02-000-e053 Agent D. Is delivery address different from item 17 ❑ s; If YES, enter delivery address below: ❑ No RECEIVED aAc,r, Service Type I3. Adult Signature ❑ Adult Signature Restricted El Priority Mail Express® 13 Registered MaIIT. Dell ❑ Certitietl Mall®n ^' . very ❑ Registered Mail Restricted ❑Certified MailR livery tri tlCeYni!►9/'f��E ❑ Collect on Delivery ❑ Collect M D¢pvery Restricted Delivery ❑ Insured Mall IY nature Confirmation*^• LLL]]] estrifted Confirmation Restricted Delivery Domestic Return Recelpt RECEIVED N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM JUL 0 2 2024 CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: 9Q TY � c, � G L 1 ij 4 cl P r Address of Property: 0 DCM-EC Mailing Address of Owner. RoO JUf\ret CI(cje. JAeY� <`.iNr 279Q9 u �y mr, , , -0 rn ) Owner's email: bl 1 I hP { �nMy 1 Owner's Phone#:rJ J Agent's Name: V� P n I r o, r I f1(I, Agent Phone#: I Agent's Email: I (1VrA8h Mn f { r:P, l" nQ-r FnQ I 1 c a- 914� 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. 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 matted to 401 S. Griffin St, Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. 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 Signature of Adjacent Riparian PradMy 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 ofARPO: �6Rfj SV✓tSCf �i� �,a��/ Nf� z!�/ ARPO's email: 60�►rt[O¢(RPO's Phone#: 6y-i37�-1/0' ki Dale: L//Z � `/ *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 Q0 �3 RECEIVED JUL 0 2 2024 DciM-EC 1 1 �c a- r p � � 3 Y ��y _ ...1. .,["ti i �- �� .__ _�-ii'_ �. 1Z � '- :..macs YY �t dlr 'n �1 r9 Ae E 0 CL