89248A - Thompson, Michael and Mary

3o"d,iourgr' OCAMA ❑DREDGE & FILL IN9 89248 A B C D
PreviGENERAL PERMIT Date Devioupermit
� Date previous permit issued
0 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: www.deq.nc.eov/CAMArules
Applicant Name _
Address
City
Phone #
Affected ❑CW
AEC(s): ❑ OEA
ORW: yes/no;.
State ZIP
❑EW ❑PTA ❑ES ❑PTS
❑IHA ❑UW ❑SPIMA ❑PWS
PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length _
Pier (dock) lengtt
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore _
Breakwater/Sill
Max distance/ length _
Basin, channel
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Mal. Wtr.
(Scale: )
❑ 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 Officer's PRINTED Name
Signature --Please read compliance statement on back of permit••
Application Feels) Check #/Money Order
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: JY t 1 We Th
Mailing address: 533 H VI'afl avenue,
Msn wako va
Telephone Number: Osil Lp-6)q- ! 59AG7
I certify that I have authorized �� �p�j (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of I DU :}- B(,t.L kheeo
at my property located at M We hh Hoe— {i-,rA m n n, it i
This certification is valid through
(Property Owner Information)
attu-r�e
11 not or Type Name
Title, co. owner or (trustee for property
Date
Telephone Number
Email Address
(date).
RECEIVED
OCT 2 8 2024
DCM-EC

ADJACENT R1I.P.LC. DRIfVr�IS�IR()yN� ROEFCCOASTAL —PT-�RE
S�UFAEAS0TJAFcn3e,.[ . E�N.�iC�TS RO?ERT! OWNER lNOTIFtCiTlOd,.
.hA_
IyER FORK
gIRIAd p
(Top POTtion
Name of property Oww �= t
Address of PrCperty_ % 7'
kaifrrg Address of Owner
Dernet's antail: (Y1i t,r?riJ ra ��
Agent's Name:
Agent's Email:
to be completed by owner or their 2 --
L l n
Owner's Phonal:
Agent Phoneae-
ADJACENT RIPARIAN PROPERTY "OWNERS NER'S CERTIFICATfON
Lrom he comillated h,...�..
RECEIVED
SEp 2 7 M4
®CM -EC
I hero rrone�— II
by ca iify that I awn property acjaceni [o he BI pe: mit has descrit+ad to me referenced Propeftas shown On the a e The indnllcual applying TOrthis
S '.tnaffgn r - Vrivrino wilt dimalslonc 1L'DZhBd drmving, the devdle mar[ - - - n')L'st bQ pR?vjd� Vrt' lhl� PaMar_ p they arc prdpasing. p,
1/ I DO NOT have rojecbans to this proposal.
—1 dd have ob r ctiors Eo ticis prop
!f You havo ob fj --
fec Ono to what IIi t leg pr u !Host
mailed to Management (S, in tavlfirtg ivPttrtn t'0 days r 30 of this Trot fy the Corhrrea l7iviaioH of Coasts!
Contacted
to 407 S, Gr&n St., Ste. 300, EOzabeth W MC, f th's, pC� r e Pondsnca c6nracted at (252) Z64-3J)Ot. ivo re aboard be
notlRed b sponso is cornsldemd the same 0s no ab' "Rion Ives can also be
Y CartHlod 6taU_ secrlorn It You have bean
WAIVER SECTION C �._.�.._..,._-._,._.,,_.•,�.� ���
I undorstand that an Lt14_o6a onto e�noi — i
Y pa min:M pier, dock, tttaort, f pilings, beat ramp, breakwater• boathouse. rift. oe
groin must ha set book a minimum distance Of t5' from (11tis 9QU not annhr to twlkhBadx or nnraO etmants , area Of riparian access unless waived by me
the appropriate Is'ank taploui (if you WrI to waive the Setback, you F siun ;
I t70 t.R3R to waiV6 aOrrtelal of, 15' setba: -
_ 1-oR- Sipnaturo WA-41 Oent Riparian, Property Owner
100 NOT wish to wa'Y& the tS. selbark ragairoment (inhial the thank)
5tgnature of Adjarerrt Riparisn pro —_
perty Owner:
lYPedlPrintedcameo`ARPO•
tllalling Address of laP.PC: .i5'C L
i+RPO'a jU: i.' %C'I'c+ t. <'ca•� t1RP0'B Phorte4l YG C> r/51
Date.•wsIvor le valid for up to vne ysarfrorn ARPD'e Signature`
Revis4d Augusl 2022

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RECEIVED
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WEBB STREF_T 0301421)
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N-C. DIVISION OF COASTAL MANAGEMENT RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
E TIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY S E P 2 7 2024
(Top portion to be completed by owner or their agent)
Name of Property Owner :-):,�n,.- 1?),s-, �N- rt DCM-EC
Address at Property 1!73 Wr_/,4, .5j- N-V --yP -� jc
Mail -rig Address of Owner _S,4l7t�
Owner's omad
Agents Name
Agent's F-naii
Owner's Phone#: _17-Ei'2 - r//,
Agent Phonery:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Boslom 00dion to be comoleted by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying tot this
permit has described to me. as shown on the attached drawing, the development they are proposing A
desefiobon or dra%Onttwith dimenwris must be ornvided with this letter
V I DO NOT have 06^150AS to this proposal. I DO have objections i0 this proposal.
tt YOU nave objections to what f5 being proposed, you must notify the N-C. Division of Coastal
Management (OCAit) in wrtNng within 10 days of reoofpt Of this notice. COrrospondanco should be
mailed to 401 S. Griffin St, Ste. $00, Elizabeth City, NC, 29909. DCllt representatives can also be
Contacted of [phone]. No reapanse is consldared the some as no objection if you have been
noWled by CerfifW Mall,
WAIVER SECTION (Choose only one
I urt "land that any proposed pier, dock, mooring pilings. boat ramp, breakwater, boathouse, lift or
gran must be sot back a minimum distance of 15' from my area of riparian access un!oSS waived by me
{this d.Oes not aDON to bulkheads nr rinse reveLmehm . (It you wish to waive the setback, you must sien
the appmpriate blank below) i x
I DO wish towaiv0 somolall Of the 15' setback z) 7Ny.---y
.OR-
iignaruns of Adjacent , iparlan Properly Owner
I DO NOT wish to we+ve the 1 S' Selback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner-
TypedlPrinted name of ARPO:
Mailin4 Address of ARPO: 01 CA)f--bh Gk t�w_f.� ,,,,a }„�', �-y-r y
ARPO's email -
Date: "7 -6 .—
ARPO's Phone#: rises 463 -- ;?2.i-3
'waiver is valid for up to one year from ARPO's Signature'
Revfscri August 2022

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RECEiVED
SEp 2 7 NZ4
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DCM*C
4 4 4
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WM STREET (SR 1421) 40'
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