89167A - Godfrey, James and Laura

o1Ate"'4N❑CAMA El DREDGE & FILL NO 89F1.67 A B C
a GPrevious permit
GENERAL PERMIT
Date previous permit issued
® New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Qualityand the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. M General Permit Rules available at the following link: w .cleq nc gov/LAMA ales
Applicant Name _
Address
City
Phone # ( )
Email
Authorized Agent
Project Location (County):
State ZIP Street Address/State Road/
Subdivision
City_
Affected ❑ CW ❑ EW ❑ 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
(Scale: " )
Shoreline I em,th
Access Length
Pier (dock) length
Platform(s)
:::'�Fixed
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CGS
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Floating Platform(s)
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Finger pler(s)�..
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NONE
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A building permit/zoning permit maybe required by:
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) -..Y
Agent or, Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit-' Signature
Application Feels) Check ft/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property OwnerAppiyingforPemilt �P'14� `� IDL) - - C,Cal rem
Mailing address: ��'K o L e 1J
Telephone Number: -7 -5
I certify that I have authorized 2UOLq-IageAcontractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of � .6p a-T" ! 4,4- —t
at my property located at
This certification Is valid through ':2I;n I a5 (date).
I*=
Licw ro-
5
RECEIVED
S E P 0 5 2024
DCM-EC
Title, co. owner or trustee for property
Date
c)(.per%
Telephone Number
I�k br-WPe�Q I I I®� Lrn0-4 CO M
L45meil Addrea

RECEIVED
N.C. DIVISION OF COASTAL MANAGEMENT SEP 0 5 2024
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWANER FORM
CERTIFIED MAIL - RET IRN flW J U UEQ HAND DELIVERY n n
(Top portion to be completed by owner or their agent) D C V' - E C
Name of Property Owner ...r � n .S cir aura- C7D c f
Address of Property. :- � 1�1�F�t7 I 1Jd 6 0 L
Mailing Address of Owner,
Owner's email:_a�on btal( wneres Phona*
Agent's Nsme`&(& IS (PJI t Y) T1Pt ttb( aj r)%J%gent PhoneffC2',?-) t4?-U- ZUI/ ;S
Agent's Emall: Bey ,'e-(b t • 1oIOIj ncQQ-Ltd) -�-ccrn
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be Como ated by the Adjacent Property Owner)
thereby 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
descri ' r d Rio us beovided with letlette, .
I DO NOT have objections to this proposal. ® I DO have objections to this proposal.
rr you nave objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DC" In wrfdng within 10 days ofreceliet of thls notice. correspondence should be
mailed to 401 S. Grift St, Ste. 300, Elizabeth City, NC, 27009. DCM representatives can also be
contacted at (252) 26"901. No response Is considered the same as no objection If you have been
nodlied byCerdNed 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 rlprap revetments). (If you wish to waive the setback, you MMILegilgn
the appropriate blank below.)
i DO wish to waive som al of the 15' setback "- r "J
•OR-
Signat ra'ofAdjacentRrpartanPropertyOwner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed7Pdntedname ofARPO: T 4Uail Drees
Meiling Address of ARPO: Q9 k rw/'
ARPO's email: -4�e 00, ARPO's
Date: g a0 'waiver Is valid for up to one year from ARPO's Signature -
Revised July 2021
J

RECEIVED
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)
Name of Property Owner
Address of Property:
SEP 0 5 2024
DCM-EC
dam k s -a d f
1�8 I<Nowt.e —'Z' 1 C/c;t-m(!
Mailing Address of Owner:I 2 9 K>J oj.ji i �-
Owner's email: , 1 C I OwneesrPconhe#:
Agent's Name: iYwos ZF-Ve Cply).5 Agent Phone#�2 �2 '
Agent's Email: t (j. t +Y t�OLc ��C t)1• CUi Yl
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Ownerl
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.
description or drawing, with dimensions must be provided with this letter.
ZI DO NOT have objections to this proposal. _ 100 have objections to this proposal.
It 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, Elisabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have bean
noted 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 ripadan 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 some/all of the 15' setback
Signature Adjacent Riparian a Pro weer
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: _
Typed/Printed name ofARPO: James D. actin
Mailing address of ARPO: 198 Knowles Landing, Hertford, NC
ARPO's email:[e-mail]'s phone#: 706.315,3684
Date: 08/20/2024 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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