89148A (MOD) - Cheek, David

CAMA ❑DREDGE & FILL N9 89148 a C D
® GENERAL PERMIT Previous permit
Date previous permit issued
New ®Modification ❑ Complete Reissue El Partial Reissue Modified 09-09-2o24AU-4f4dieff
As autherired 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 n • I Zn V ❑ Rules attached. Q General Permit Rules available at the following link wvnv.deq nc.gov/CAMArules
Applicant
City P} uO.rbroNf -Slate 1'1 �. - ZIPS9, G +
Phone N asj- )
Email do%jA ,L G'- r'kaAcr-1,"4
Affected ❑cW ©EW
AEC(s): ❑OEA ❑IHA
ORW: yes(0 PNA: p
Type of project/ Activity T@
Shoreline Length IC7(A r
Access Length
Pler(dock)length
Fixed Platform(s)
Floating Platforms)
Finger pieralength
Total Platfo
Groin lengt
Bulkhead/ Avg distancBreakwateMax distanBasin, chan
Cubic yards
Boat ramp_f__
Boathous Boatli 2• sa•. !i
Beach Bulldozing
Other
(12,5-X12.5-1 �z
&PTA ❑ ES ❑ Mrs
❑UW ❑SPIMA ❑PINS
PROPOSED
Authorized Agent LeiT Mo'r—I2A P_
Project Location (County): cjker I Anu r k
Street Address/State Road/Lotsy(s) Z3C•:,�n
65 ^S AGsty S
r ,
Subdivision
city Poi .4 14ct r6er ZIP i 9
Adj. Win Body A 11I ice 6 Urt.lf .tttatlataAJunk)
Closest Mal. Win Body A\6eoA&,Ar OAUNA
^� Pl�ory.•T
DOUBLEJET
SKI LIFT � A4 m
1�
3rJlkL-1 J--
U (Waived)
o- tT- ,M.La.A1 Cb �T lc
SAV observed: yes pa2ry
Moratorium: �/S1.' yes no l
Site Photos: ey€s) no
Riparian WaiverANached: YW is0b N I
A building permit/zoning permit may be required by: r,• rt-s -irs1Ck Lot s^,4,1
_42fl(Scaled"=Lo )
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❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditlons on back
I AM AWARE OF STATUTES CRC RULES AND CONDITIONS THAT APPLVTO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Pleaselnidal) 'MVM
Monica L. M. Small M .k t jA i a-eA e l i,
Agent or Applicant P I
INTED Name Permit Officer's PRINTED Name1
✓) t tf
I l.A'YLA�tL 2/� iA�4-
Signature '-I read complian e s secure on ark of permit•• Signature '
#A eLt)U :3 2 S 2Jig
Appliwtlon Feels) Checkg/Money Order Issuing Date Wilied aO9.2024 Expir
MLIL't kit lion Dae

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 17A1%IL-) % is
* M =✓
Phone Number: 71_ % t6 t 3JJ--7
Email Address: nA 1Z Q . C /+G Vk' f o/ C /{ 4 k la7= • A/D"1
I certify that I have authorized A 5 r W,`A7 fP rAa/s LTZt��I"ze
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: R-r /d/s L" t_ P14,1
No (sT Lc: t f s r`iA/4 - a U t_tf HrAo
at my property located at 11-5
in Ltirw4r-trt,{i:� County.
l 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.
Property owner Information:
—t Signature
D l_ G Ht 1�-K
Print or Type Name
Title
p5 1_)-&- l;L6j-4'—
Date
This certification is valid through /I l A-r 1� 2n&a {-

N.C. DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner:
DAVID CHEEK
236 GRIGGS ACRES DRIVE, POINT HARBOR, NC 27964
236 GRIGGS ACRES DRIVE, POINT HARBOR, NC 27964
Owner's email: DAVID.CHEEK@CHARTE%LTs Phone#: [phone]
SCOTT SMALL / LSI MARINE
Agent's Name: Agent Phone#: [phone]
Agent's Email:
[e-mail] / MONICA@LS)MARINE.COM
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom nortion to be completed by the Adiaeent 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 drawino with dimensions most be provided with this letter.
100 NOT have objections to this proposal. I DO have objections to this proposal.
N 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 [phone]. No response is considered the same as no objection /f you have been
notified by Certified Mafl.
WAIVER SECTION
I understand that any proposed pier, dark, 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 dprap revetments). (If you wish to waive the setback, you m 9j1111L
the appropriate blank below.)
�f }j /
I DO wish to waive eorne/ali-of4he
-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:
WILLIAM C & ANN E SHEPPARD
Mailing Address of ARPO: 240 GRIGGS ACRES DR, POINT HARBOR, NC 27964
ARPO's email: all 05N,26 2 rh Et + PARPO's Phone#: _ %Z �! —t% I
Date: j "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 NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
DAVID CHEEK
Name of Property Owner.
Address of Property: 236 GRIGGS ACRES DRIVE, POINT HARBOR, NC 27964
Mailing Address of Owner:
236 GRIGGS ACRES DRIVE, POINT HARBOR, NC 27964
Owner's email: DAVID.CHEEK@CHARTEIb4Us Phone#: [phone]
Agent's Name: SCOTT SMALL I LSl MARINE Agent Phone#: [phone]
Agent's Email:
SCOTT ,LSIMARINE.COM I [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 for this
permit has described to me, as shown on the attached drawing, the development they are proposing_ A
desgriptign or drawino with dimensions, must be provided with this letter.
b&j t- I DO NOT have objections to this proposal. I DO have objections to this proposal.
N you have objections to what is being proposed, you must nary me rv.u. urvisron or wawar
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 somelall of the 15' setback
Signature of Adjacont,Riparian Property Owner
-OR-
i do not wish to waive the IS setback requirement (initial the blank) �—
Signature of Adjacent Riparian Property Owner: L
TypedlPrinted name of ARPO:
BETTY K WISE,
Mailing Address of ARPO:
232 GRIGGS ACRES DR, POINT HARBOR, NC 27964
ARPO's email: AsPyj�4dAj+Y ARPO's Phone#: Asa - °�aa-57a2,
Date: �� walver is valid for up to one year from ARPO's Signature*
Revised July 2021

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