89253A - Nelson, William and Elizabeth

&❑CAMA El DREDGE & FILL N� 89253 n B C D
GENERAL PERMIT Previous permit
140 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 � i I-, ❑ Rules attached. E] General Permit Rules available at the following link: v w vdemnceov/CAMArules
Applicant Name
Authorized Agent
Address
Project Location (County):
City State
ZIP
Street Address/State Road/Lot #(s)
Phone # I—)
Email
Subdivision
City ZIP
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: )
Shnmlina I anvth
Access Length
Nip
Pier (dock) length
Fixed Platform(s)
ME
M
M
1000111"
ME
MINI
ME
Finger pier(s)
®■MO■M■EME�ME
EMEM�ME
Max distance/ length
Cubic yards Boatramp..■■�
Bulldozing
I
vi�iMOMMEMEM
��v�
1
ace
110
.NEEM.�:
M
NE
NE
®W■■■■■■■■■■■■
■■■■■■■■■■■■W■
•■.
:
NOON
M'■:C�'C
9....�':E1
11MM■C■M:
:C:I
MEN
Q=Laix�
1"Ni4olma
..CBeach
■ini
M■.■
■■
■■M■
■■■ME■■■■■■■
■
SAV observed: yes no
Moratorium: n/a, yes no
Riparian Waiver Attached: r ye _=MENOMMUMMEN
yes no
MEN
A building
permit/zoning permit maybe required by:
Permit Conditions
❑ TARJPAM/NEUSF/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 FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Gy, , / (, /Je%1 /
Mailing Address: 11 p 0 / ewn fe,r S la/A / K rr✓, 6: ,j /" � l j
Phone Number:
Email Address:
I certify that I have authorized
,� 7, i ,�" / � - `I % r &
ii ; 1l,c,"-(G corn ,ltt-f`f,
L , // }/ A �017 cv'/, S fPtlCfr, r I1 G
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at t t 0 k; f/: F er C t H PNtf eF rJ / ) %7� `f `7
in Prr County.
I furthermore certify that ! 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:
Signature RECEIVED
Print or Type Name
NOV 0 4 2024
Title DC �_CC
l.i1Vl C
Date
This certification is valid through

N.G. DIVISION OF COASTAL MANAGEMENT RECEIVE®
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY NOV 0 4 2024
(Top portion to be completed by owner or their agent) Name of Property Owner i. - DCM-EC
Address of Property:
Mailing Address of Owner
Owner's email:,,,; 'i'rs. ^ =fit^' "
`Owner's Phone#:
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
1 hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawino with dimensions must be provided with this letter.
Lt'I56 NOT have objections to this proposal. I DO 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, 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 some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback ygquirement (initial the blank)
U i -;;,
Signature of Adjacent Riparian Property Owner
Typed/Printed name of ARPO: SOPHEAP TENG
Mailing Address of ARPO: 104 KILLDEER CT. HERTFORD, NC 27944
ARPO's email: SOPHEAP_TEIAGCa)AHo0-Cora
ARPO's Phonett: 571-332-6040
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT RECEIVED
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY N0V 0 4 2024
(Top portion to be completed by owner or their agent)
Name of Property Owner:, r G. M A% c 6 st7A/
Address of Property: Ito k; rl d ee ` C f He`F fotol
Mailing Address of Owner: ((8 P/.4 art tvsrlk AY ffie 1(1,C;
(GOM i
Owner's email: (a%il.'in . (r/enn..yflsia�frMt'5w,ner's Phone#:
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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.
X 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 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
1 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 -1
SignatOb 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: � .J W// • - r o v✓ -) 3 r /
Mailing Address ofARPO: �(�� ��t��dee� `'a�tr� %fCr��ur�+,A)
ARPO'semail: Jok^'LJobrow OCARPO'sPh ne#: \,45"2) �6�2-SSs 6
Date: i i ..1-a q*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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