89233A - Clark, Patrick

�`0e" CZCAMA DREDGE & FILL W 89233 �
�B C—D
�GENERAL PERMIT Previous permit
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 0 —1 1"4 I lr > ❑ Rules attached. General Permit Rules available at the following link mtyydea.nc Pov/CAMAwl
Applicant Name f r, �YI l k (< Y L'-- �!
f. n Authorized Agent ILnut-ei.trt z1e,r
Address I--; b (c)[, `i `" ton Project Location (County): rd Lt�u C
City qa c State WC, ZIP 79 s?.ti 53 Street Address/State Road/Lot#(s) i 1'� 6 1��,�cj�
Phone #(_) is C & Yarx.tf
Email 9 .In C �. r
�r.�ss7(�__.�E�'h3;j,tl nSyt Subdivision rU(k,i Uq tOs\•J
Affected ❑cW 9EW
AEC(s): ❑oEA ❑IHA
ORW:yeo-
Type of Project/ Activity
Shoreline Length t 34, t
Access Length
Pier (dock) length
Fixed Platformis)
Floating
Finger pier(s)
Total Platform area I
Groin length/it
Bulkhead length
/4tipreplen h_
Avg distance offshore
Breakwater/Sill
Max distancePfilllM %Z r
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlih
Beach Bulldozing
Other JZa •!!i w\.
City M C01064,— , . 'zip 21tX59
PTA E!(ES ZPTS Adj. Wtr. Body L' 2�d iTl ALJ 4 11,li S i` (n r ials/unk)
❑UW ❑$PIMA ❑PWS Closest Maj. Win Body b l"00yZffffIffCa—'5��s�/
C_ A 0 A t.. ` ` V +l
ooRs'(NiAJL-:i V
cz.ty �r2
N Vic-
(Sca
v t k uA A
NW L
.1A
16 U L, K-It C /1:.T)
_ NW
W observed: C'
es no C17 I
Moratorium: a yes no �7 v1,61sUaJ
Site Photos: es no �1U, Zi vi a
Riparian Waiver Attached: no
A building permit/zoning permit✓may be required by:a L'_�_ t_s
Permit Conditions
CRC
Applicant PMTED Name
Signature **Please read compliance statement on back of permit'•
is c�rY> ca 6 9 L> I
Applicc on Feels) Check k/Money Order
R-
I(w,t,tVc 0
❑ TARtPAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
See additional notes/conditions on back
AND REVIEWED COMPLIANCE STATEMENT. (Please Initial).
M,V,r-- i' qi M lr--' 1y `/
Permit Offlce,s/s PRINTED Name
/% I
Signatur
7-4 7
Issuing Date Expirad Date

��conru VCAMA dDREDGE & FILL
GENERAL PERMIT
VNew ❑Modification []Complete Reissue []Partial Reissue
N° 89233
Previous permit
Date previous permit issued
�( AZ/ C D
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 n-714, t 10b ❑ Rules attached. General Permit Rules available at the following link: wwwc1pq nc gov/CAMArules
Applicant Name en T%1 l�k„ C'kn r L'
Address rosin ruj�s Cwek 9,oQ.d
City Mo,,�State �ZIP 2-19'513
Phone # ( )
r
Email PCIl..r L 2!57 Q. ina�jljp(,�,L� 6iy'L
Affected ❑CW gEW gPTA ®ES dPTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: ye no PNA: yet T
Type of Project/ Activity P, w t 4G i° 4 tS ke G
Shoreline Length L ?Y-i 1
Access Length
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area f
Groin length/q
Bulkhead/4Wpmp length
Avg distance offshore ? r
Breakwater/Sill
Max distancetl2Rg[ll 7-
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other V.'- J
Authorized Agent IX1 U TGVI 13 r i r, At I rC;l
Project Location (County): C t4, r t t t u[ L
Street Address/State Road/Lot#(s) 13 `1
Subdivision Tu1t-S 944 GG 1anV
City M 6JdL t 1 ZIP r.
Adj. Wtr. Body t-QYI.cC-� }c. %%�'�Ii.W 5*k _(n;:m)Junk)
Closest Maj. Wtr. Body O CJC A te� tk ?—I J C r-
e:At4XL- `i0
N v-X;Ttk+JL5T
)U V E 2
014
SAV observed: yes no QhG�
Moratorium: n a Lr
yes no v
Site Photos: yes no
Riparian Waiver Attached: no
A building permit/zoning permit may be required by: [.tu
Permit Conditions
0?1aA'%65
a1
R
I
Itslllf
•1/
F_
N u�
zf gtl
P
I e2
Icwa.t V C4J
❑ 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)
Agent or Applicant PRINTED Name Permit OfficeA PRINTED Name
ar tG Inc- G- Gnlit �el�
Signature "Plea e read compliance statement on back of permit• Signatur
"c� 2_9 0 1 Zvi
App�llc on Fee(s) Check ft/Money Order Issuing Date Exi3iraticIn Date

&000A5t° ❑CAMA ❑DREDGE & FILL N° 89233 A B C D
3 GENERAL PERMIT Previous permit
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:
I SA NCAC ❑ Rules attached. ❑' General Permit Rules available at the following link: w_cleq nc gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
State ZIP
Authorized Agent i. -r'r.
Project Location (County):
Street Address/State Road/
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑t ES M PTS Adj. Wtr. Body - (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA DPW Closest Maj. Wtr. Body
ORW: yes(*no i PNA: yes/no
Type of Project/ Activity 0 v' t t r •:r
(Scale:{
�herPIIrIP IPnOttl I �..�� �
Access Length
Pier (dock) length
Platform(s)
'
MFixed
.:.E..
�■
■■�im�i
ii�
ii■i
.■
■
Finger pier(s)
Mal
I
1
0
Total Platform area
SEEM
SON
M
-
M!'
M
.■1�.
■EN.�..■1�!!■
M
�����
■
i
��MO■■■■M
A building permit/zoning permit may be required
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)
Agent or Applicant PRINTED Name Per
mit Officer's PRINTED Name
t I
Signature -*Please read compliance statement on back of permit" Signature
Application Feels) Check M/Money Order Issuing Date Ezpira;' n Date

�� x'[
„,x
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
i
Name of Property Owner Requesting Permit: Patrick Clark
Mailing Address:
1375 Tulls Creek Rd
'z Moyock NC 27958
Y:'
Phone Number:
Email Address: [e-mail]
certify that I have authorized Lauren Berry Burch
Agent ( Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: constructing 88' bulkhead with 4' west return
8' East return
}
„t
at my property located at 1375 Tulls Creek Rd Moyock
,
in Currituck County:
1 furthermore certify that 1 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.

N.C. DIISION OFCOASTAL MANAGEMENT
ADJACENT RIPARIANVPROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND D LI E Y
(Top portion to be completed by owner or their agent)
Name of property Owner. Patrick Clark
Address of Property, 1375 Tulls Creek Rd Moyock NO 27958 �--
Mailing Address of Owner: 1375 Tulls Creek Rd Moyock NC 27958 ------
Owner's email: [e-mail] Owner's Phone#:
Agent's Name: Lauren Berry Burch Agent Phone#: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
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 drawingwith dimensions must be rovided with this letter,
s t DO NOT have objections to this propos 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
Matrgggment (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Gruen St, Ste. 300, Elizabeth City, NC, 27909. DCMrepresentatives can also be
contacted at [phone]_ No response. is considered the same as no objection if you have been
ndfi6ed byCert/fied 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 riparfarl'seces9 unless waived by me
(this does not apply to bulkheads or riprap revetments). (If ou wish to waive the s back, you must sign
the appropriate blank below.) i J � �' I ,
I DO wish to waive some/all of the 15' setback X L / I v4- 2 A ✓ - f�
Signature of Adjacent Riparian Property Owne
_OR_
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: // �L pp
S
i Typed/Printed name of ARPO:: 96V / d 5O � 0 !'P a-
. -- Mailing Address of ARPO: rj f y n� 1-1 �P5 Cx ewe /r ^�Ig d ( %%74�j(�� J% �.��v�
ARPO's email: �t ^' f ARPO's Phone#: 7 S / - � l <9 9Ot' T
Date: % " � 1 " oC`1 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT AVER FORM
An.taCENT RIPARIAN PROPERTY OWNER NOTIFICATION D DE
LIY
(fop portion to be completed by owner or their agent)
Name of Property owner: PaUick Clark
Address of Property: 1375 Tulls.Creek Rd Moyock NC 27958
1375 Tulls Creek Rd Moyock NC 27958
Mailing Address of owner
Owner's email: Pclack252@Phone*ail.com Owners PhoneAgent Phone#: [phone]
Agent's Name Lauren Berry Burch
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 l own. property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached d
ttach d drawing,
this letdevelopment they are proposing. A
` 1 DO have objections to this proposal.
�._ I DO NOT have objections to this proposal.
I f 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 setback, you must sign
the appropriate blank below.)
,a I DO wish to waive some/all of the 15' setback X
Signature of Adjacent Riparian Property 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 of ARPO:
ARPO's email -' ARPO's Phone#: _
-- Date: r7_029`waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

�z~a. � � ! �© � �
. % © x •
, ` �/ » �
* • �:
. d, \�� 2\^ ^ � :
\ � % \ . . d� £ , � . . x
� z . �
v��»� » �. 2 � ,. \ » y»: y .
� � � -: ,� �y -^?w2z :
`� �\ ��\�� j• �\ , : � �.
.\ �� � � \\\� \ \ �� \ \ /� ` ` \\
<w»< � `
� »»2\:kgf� \� � �
- \ . � /�
~� ���^.���� /y � \\
{} �
� `���\2� .. �� /
�� � .� \�� ^ �. \
. %»9 4