89125A (MOD) - Yang, Ju

1d�uW L")CAMA ❑ DREDGE & FILL
GSYERAL PERMIT
&Cv [Modification L Complete Reissue ❑pa
NY
08
Previous permit ��2
Date previous perm)t issued k2 `
rtfal Reissue Modified 9-18-2024
As authorized by the State o! Nonh Carolina, Department of Environmental Quality and the Coastal Resources Commbs:on in an area olenHronmenrnI firirrem�pwsea
ISA NCAC_ p;
d7ii 1ZQ
— — — ❑Rubes attached. C'fGeneral Permit Rutesavailable at the ed1,1MIS link: w n •.. /era
APP1Kant Name l
Address
City d1�5,-Qctt State_ VA ZIP 234 .55
Phone#!(] .' 3 — ,—y—
Emaily�Q�a.�,
Authorized Agent
Project Location (County); . .12 yY _ V
Street AdrexiStaw Road/Lot k(s) I1l AI rL. ;;
Subdivision
City Ji,a i•k ZIP_ 2.79d+51
dlected ucw 9EW PTA ES [JPTS Adj. Wv, BodyLk" l4.Ct._6 o-Y"tg L inantunk)
&C(s): 110EA EJiHA E]UW []SPIMA OPWS CbsestMal.Wtr." C,%A-VY1L&Ck SrZLkd _
IRW: ye no PNA: ye, to
fpe of Project/ Acdvlty - oaf-9vo:Resize proposed roof from 15' x 17' to 11' x
16' and. ealoca tat to waterward-most platform. ,ffelII (scale: NTS 1
hemline Length gtla
455 . IC.L'.'1(
Dial Platform area
min length/A-
C1st22LTJ[K 30uMa N ) bt(W
I
I - F T 6 VF-`IZl4&4C, 'teSsU 1.T5 IF�
. F•f-Z a1
ftat'rioPAL, Sl4AS)lflCt T-OfR
P¢oPUSE� h� i�' 11'x 16' ,lfL',Il
RELOCATE RESIZED COVERED PLA
ulkhead/Blprap length_ _
vg distance offshore
"
�e--
reakwater/SIII
Xo
o p —, and ' la
tax distance/length
t'
asin, channel
l
abic yards
oil tamp
oathowe/ Boallift
each Bulldozing
ther t
'].r evsk.•�_
�.
W observed: yes
loatorium: Yes no
le Photos: CTED no
portan Wit lver Attached; no
building permitlioning permit may be required by: Taw to 6�
armil Conditions
Srgnasote'rpleaseread camptiantestatement on backaf permit'
1jLP bD O f"'�i Check RlMogeYOnter
TO HERE �� q
7,oa fo
M IyRLMp�O R..
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TANPAWNEUSE/BUFPER (circle one)
See note tmbackaegatdingNvet eosin Mea
See additional WAmlcand dons an back
>REVIEWED t:OMPLIANCESTATEMLNT. (Please lnibaq_s.
�,mit officar'S.PRINTED Name
signature / 9; 2.
�I E Pi le
Iss%ingDate
Modified 9-18-2024 ffe ((its

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 't
Mailing Address: 1 2)-`d S1 ,kWF-Q(-- f "t
V P, C>GAc-1-1 V A
Phone Number:iSrT
Email Address: SJ A A> r Q 4A0L? 6otv1
I certify that I have authorized Cie eT- I O Lst t Z
Agent t Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: L4 � l4 Lf>WGR i T h
at my property located at ,it N�St4_C-T I uGK, NC-
in ! zi;< County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Prooertv owner Information:
tt 2 tt
Dat
This certification is valid through I t

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONPINAiVER FORM
(Top portion to be completed by owner or their agent)
Name of Property Ownar.
Address of Property:
Mailing Address of Owner: S'ltxkt:%z ,, «_. !tij?, ,;}�({ i✓:;1 2-3 �j `as
Owner's email: 4.` 71/0 r1�-Owners Phone#: •/J�-���2��s
p 252 -2
Agent's Name: oO•crT lut q �.� Agent Phone#: U2
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that i own prorerty 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 lettg .
I DO NOT have objections to this proposal. I DO have objections to this proposal.
it you nave obiections to w1nn rs .idly p.wrv—, rwu -ow— ••-..., ..._ ...-. ----- ------_..
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 pi ings, bo ra p, bre kwater, boathouse, lift, or
groin must be setback a minimum distance of 15' fro my ar old n access unless waived by me
(this does not apply to bulkheads or riprap r tmen ). (If yo ,w waive the setback, you must sign
the appropriate blank below.;- � t ;
I DO wish to waive somelaliof the 15' tback %
Signature of Adjacent Riparian Property Owner
-OR- rY1
.I do not wish to waive the 15' setback requirement (Initial the blank)-
�4Signature of Adjacent Riparian Property Ownei:
kA Typed/Printed name of ARPO:
Mailing Address of All
ARPO's email:
ARPO's Phone#:
k ✓Date: G 2C�.�'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top pertion to be completed by owner or their agent)
Name of Property Owner:_J.,;'k`v _.._
Address of Property. 't V. ;l i `;r T t.) ,, ' K :2 (i 2 __
Mailing Address of Owner: G`5 5-lCi`.;kiz, z';. u— ,'y �,:��:;-�; "'A �J,�155
Owner semail: .�_z ei s Phone#:
25'Z - G= �
Agent's Name: � �'-'�. � "� I i�A � 7 r Agent Phone#: 5 3
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto 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 d_mensions must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If youyou have objections to what 1s 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 pi rags, bPre , bre ater, boathouse, lift, or
groin must be set back a mirmum distance of 15'fro my n access unless waived by me
(this does not apply io bulkheads or dprap re>li�.,tment ). (If yowaive the setback, you must sign
tha appropriaie blank below.� t --
I DO wish to waive sometall!of the 15' e'back
Signature ofAdjacent Riparian Property Owner
-OR-
�4I do notwish to waive the 1$'setback requirement (initial the blank), �u
Signature of Adjacent Riparian Property Owner` A'lv-U--1— V
Typed/Printed name of ARPO: E \)a -% {le Ct
,--� '
Mailing Address of
ARPO's email:
ARPO's Phone#:
!1,C,'Date: _'waiver is valid for up to one year from ARPO's Signature
Revised July 2021

LIFT ---
4X16
LOWER PLATFORM
LIFT
OX16 DECK WITH
HIP ROOF
EXISTING PIER

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