89164A - Sparkman, Tommy and Debray

A"OW"&FICAMA EJ DREDGE & FILL N9 89164 A B C D
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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. General Permit Rules available at the following link: wwwdeo nc gov/CAMArules
Applicant Name
City
Phone # ( )
Email_._._.
State ZIP
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑OEA ❑IHA ❑uW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
ShnrelinP I Pncth
ES ❑ PTs
❑SPIMA ❑PWS
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision i
City
Adj. Won Body
Closest Maj. Wtr. Body
(Scale: )
P ier (dock) length
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Fixed Platform(s)
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Floating Platform(s)
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MEN
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Finger pler(s)
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A building permit/zoning permit maybe required by:
Permit Conditions
❑ TAR/PAWNEUSE/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 officer's PRINTED Name
Signature'*Please read compliance statement on back of permit"
Application Feels) Check R/Money Order
Signature
Issuing Date Expiration Date

RECEIVED
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS AUG 2 6 26A
)CM -EC
Name of Property Owner Applying for Permit: _Tommy & Debray Sparkman
Mailing address: _14004 Bridgetown Cir
_Chester. VA 23831
Telephone Number: _804-778-7713
I certify that I have authorized _Browns Land Developing
(agenticontractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of _replacing bulkhead
at my property located at _379 Goose Nest Lane, Hertford, NC 27944
This certification is valid through _2/28/25
(date).
(Property Owner Information)
Signature
Print or Tye Na e
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Title, co. owner or trustee for property
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' Date
Telephone Number
AA Y- Z < F S -I.
Email Address
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DECEIVED
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
AUG 262624
DCM-EC
Name of Property Owner: t 40-\(my _T�)2 kJ + _ Alt `7< ;Y tr i�i V lJ
Address of Property: y�2 f t©DSOf � L i
Mailing Address of Owner: iv()
^� ewk
owner's email: i_ Orli L Z IrJX7rflk. Owners Phone#:�Zl`( 71tg'7�13
Aponte Mama- R (i1L. ,s LfA(\Abettiooig Agent Phone#: c2Yc;� ` q a(o — & U
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.
iiiiii
NOT have objections to this proposbjections to what is being propo(DCM) in writing wKh/n 10 days of1 S. GrlPffn St., Ste. 800, Elizabeth [phone]. No response fs conertified 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 dprap 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 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: A4_q�vro�tE%/W_ �`amA. CA. ARPO's Phone#:
Data: 8- j?- ZO">= `Waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

RECEIVED
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: 10 YYtM
Address of Property: -E-nnt EOUSC
Mailing Address of Owner:
Owner's email: f\S')ad
Agent's Name:VL. (_ lam',-
Agent's Email: skd i1 16 P nc �)
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent 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
AUG 2 6 M4
DCM-EC
JC-27q`c
i
Phone#: 0y i- ? o- -7-7 I-3
Agent Phone#: 04.E of uu _ 3 �S,3
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 nonry me mu. urwsron ur w+usrd,
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 f252) 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, bj�water, boathouse, lift, or
groin must beset back a minimum distance of 15' from my are of r p akaccess unless waived by me
(this does not apply to bulkheads or riprap revetments). (If y wish anre the setback, you must sian
the appropriate blank below,)
I DO wish to waive someiall of the 15' setback
-OR-
I do not wish to waive the 15' setback requirement
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: (I �\.
Mailing Address of ARPO:
G
..-, S-r L
ARPO'}(� i �• c u ta�cd ✓ ( ARPO s Phonem
Date: LL4---"waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

t Measure
Move the map and add points to measure distances and
area
Length
172 ft
A
�EOEIVED
AUG 2 6 2024
ocM-EC

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