89354A - Taylor, David

°"°""�❑LAMA ❑DREDGE 8t FILL N9 89354 Ai B C D
° Previous permit
. GENERAL 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 ❑ Rules attached. EJ""General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City "
Phone # (_ )
Email
Affected ❑ cW
AEC(s): ❑OEA
ORW: yes/no
State
ElEW ❑PTA
❑IHA ❑UW
PNA: yes/no
Type of Project/ Activity ., 11
rnew
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform
Floating Platform(s) I
Finger
ZIP
Authorized Agent I�
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
ES ❑V PTS Adj. Wtr. Body
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
e.+ VX lyt pkf pw• be6;de e'X s)
If X 12, fftfce Pttr,
ITT
Total Platform area 1 J A. r t
_.
Groin length/#
Bulkhead/Riprap length
--.----
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin, channel
Cubic yards
Boat ramp
I
Boathouse/Boatlift�
Beach Bulldozing
Other
_.L
_
SAV
observed:_
yes no-v�'—
Moratorium: - n_/a)
yes no -
Site Photos:
yes no
Riparian Waiver Attached:
yes no
A building permit/zoning permit may be required by:
Permit Conditions
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJEC
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit-*
o
Application Feels) 1, Ch`e!) /Money Order
(Scale:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
0 REVIEWED COMPLIANCE STATEMENT.
(Please Initial)
r
Permit Officer's PRINTED Name ,
a�
Signature
r_
Issuing Date Expiration Date

tAQ*U`rr'tr' ErCAMA ❑ DREDGE & FILL _'= AB C D
GENERAL PERMIT Previous permit
� Date previous permit issued
El 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.d .nc. ov CAMArules
Applicant Name _
Address
City -
Phone # (_ )
Email
Affected ❑CW
AEC(s): ❑OEA
ORW: yes/no
State
❑EW ❑PTA
❑IHA ❑UW
PNA: yes/no
Type of Project/ Activity
ZIP
ES ❑ PTS
❑SPIMA ❑PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision "
City
Adj. Wv.. Body ,
Closest Maj. Wtr. Body
ZIP
(Scale:
Shoreline Length
-
Access Length
Pier (dock) length
Fixed Platformis)
krm
Floating Platform(s)
Finger pier(s) x'-
P:a ailid. per
-.—
—
Total Platform area (3 Z
_
--__
....__z .. _ ,�__.:
Groin length/ft '� -
_
•
Bulkhead/Riprap length
-. •
, ;
Avg distance offshore
Breakwater/Sill -_—__ __.-_._-_,
Max distance/ length
+
Basin, channel — -._._
`-. ;- -; '....
Cubic yards
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 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)
Agent or Applicant PRINTED Name - - Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Feels) Check tt/Money Order
Signature
Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -UUu'j LW Ir^,r
Mailing Address: iZk Le- 1210(,TC �rZ
Phone Number: 'Z-cl1 " -13S Z
Email Address: l�4UT,v�a-L, G�
I certify that I have authorized
Agent!Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: rt!�
at my property located 6f 3,L' 25 -T�y-KL G U&-
in �)A-dLC County
! 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
TC%"IA. Tan Ior
Print o Type Name NOV 0 8 2024
Title C h /i _ E C
`C t 17 t� e ® �/
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER 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: ytC J7q qqj
Mailing Address of Owner:
it r
Owners email:-_baylC(,� G t'1nt✓ iA, �C:t9Wner's Phone#: S(L 5 ` 29J "73.!r2
Agent's Name: �r.�-gC m, � �: i�i� Agent Phone#: -ZS Z_-_Z � Z- 70 j
Agent's Email: I I - �' h._. C ^n) _
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.
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
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 .naive the setback. you must sign
the appropriate blank below.) / Y
I DO wish to waive somelall of the 15' setback 4
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: r� !- ^ 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MA,L RE'URN REC"PT RECU""TED or HAND DFL;VER"
(Top pocncn to be completed by owner dr thour agent)
\ame ^' P2penY Own.e. _ .
ACdruas It Propery �.._ '- Ih: • n I,,
M1(an:ng Add�ess ul Owner
Own¢''a email ..,i `, q t ..rsr.•,r,. et. .;, - ; 's.. Z
Agant s Name Ago,] L i_ AgemsEra I_; f
--r y«......:.� _........__ __.____.._..
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Bottom Pe rtlon to be gorepifeoud by the Ad' t property Ofenfur,
erabvper ".haltownproperty atl aces,, the'o"e refereq:as cmpeny. Ttiemdl efuliappiywq for thv.
,9rm,i §as jrxcllb000 :o me .45 aeown ;;n the ot.on.o drei -tg.the nevetoP n nt t"Y are ornogsng A
tas o10u nor zawnfi_ 1199=@�".=n'.i,£_g rx- eg�.-�lt'.h..s_&";
I CO NOT nave objapbb'e :o Ihs proposal I OO have abjeCaons to ha 0roposa
I1 you have ob/acf(ona m whet ly being proposed, you muaf noOly the N C Orvta:on oI Cngral
Management (DCM) In wddng ofthlo 10 days Oe MCSIPt Of this notice. Correspondence shoWd be
ma0ed to 401 S. Griffin St, Ste. 000, Shi -bolo Ciry, NC, 27909, DCM representatives can also be
contacted at [phone] No response is conalderad the same as no objacNon it you have been
notified by Certifiod MaA
WAIVER SECTION
ondersans that my proposes Alec dccx. n+cp ng P 4'q3. boat.aap breakwater. "lot- l�ae "n. or
grp:n 2.a( to i2 Cacti a min n pft ...tacos at ! n from my area cf npanao aloes by mq
A" does apt apply @ bulkheads or'Crap revetmr-n{sj fir ypn-wlaR'il waive the 9e'.^.dLk ynG mdet seq.
Ipe aPPIWIW. b.."k ba14u.' i
1 DO vnxn to Name semetnll pf SFe 13 sefbeck
fu .....
ffigrafure of ad/eeoCe nP i7rpanar! Props^v Owner
d'. do net w,se io .vaiia IDe 1 i 'e be a recu,ic [ �t 3ue`31 Lne ]lank
✓ S,gnat�re al Adjecrnl �,,yirtan Proper," Owr�:r
r TYPed%Pnnted name of ARPOO:: 0jzAA,1q—. j� .
'-�M,lling Address,of ARPO ry ��pV�/h��♦'"T
$ 1^JJit4U 6.. '/Ti A _ RPO'a Ph�L.3_3t1 wt C1 it ��
a'em/ml! _ y`v�s`+'€�s..atr4-�
�s�.Iid for up to one year from ARPO-s Signature- ReoSoU _r'y 20"

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