7-24 PERQ - West, Mark

Perguimans County 7.24 PERQ
Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environmental Quality and the
Coastal Resources Commission for development in an Area of Environmental Concern
pursuant to the Coastal Area Management Act, Section 113A-118 of the General Statutes.
Issued to Mark West, authorizing development in the Estuarine Shoreline (AEC) at 128 Pine Street in the Snug Harbor
Subdivision, in Hertford, as requested in the permittee's application, dated October 4, 2024, received on October 4, 2024
and received complete on December 2, 2024. This permit, issued on December 5. 2024, is subject to compliance with
the application and site drawing (where consistent with the permit), all applicable regulations and special conditions and
notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may
cause the permit to be null and void.
This permit authorizes: Construction of a wheel chair access ramp and walkway.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on October 4, 2024. jGS 113A-120j
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations. [GS 113A-120)
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit. [GS 113A-120]
(4) A copy of this permit shall be posted or available on site. Contact this office at 252-264-3901 for a final inspection at
completion of work. [GS 113A-1201
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permidee or other qualified persons
within twenty (20) days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for
compliance. Any maintenance work or. project modification not covered under
this permit, require further written permit approval. All work must cease when this
permit expires on: DECEMBER 31, 2027
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the writlen approval of the Division of Coastal
Management.
Check #182, in the amount of $100, was received on 1202024 for the
permit fee.
Cynthia Rountree
Field Representative
401 South Griffin St., Suite 300
Elizabeth City, NC 27909
PERMITTEE
(Signature required if conditions above apply to permit)

Name: John & Donna Moore
Minor Permit # 5.24 PERO
Date: August 19, 2024
Page 2
(5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by
effective sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of
filter cloth must be installed between the land disturbing activity and the adjacent wetland or open water areas,
until such time as the area has been property stabilized with a vegetative cover. [07H .0209(d)(3)1
(6) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all new
developmenticonstruction shall be located a distance of 30 feet landward of Normal Water Level. No portion
of the roof overhang shall encroach into the 30 ft. buffer. f07H .0209(d)(10)]
(7) All development shall comply with the following mandatory standards of the North Carolina Sedimentation
Pollution Control Act of 1973: ]07H .0209(d)(3)]
(8) This permit does not authorize development within any wetland or open water areas. [GS 113A-120] and [07H
.0205(d)]
SIGNATZ DATE. —�
PERMITTEE

(For official use
GENERAL INFORMATION
LAND OWNER
Name -(I Ct W i< G
DCM—EC
Address 1 1�'sj 9 r,'- 5r
City tu''8r-$Ford State -IV(,' (,' Zip 27 j / Phone ,77,237 W,2
Email Ke ` V &S r C, re Q 6rowL • CO/f'g 15?— 390 — *7075'
AUTHORIZED
Name
Address
City
State
Zip Phone
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody) Same ps Rbrl t / yo p u' r ' Iy v ` f lulu dut�fi } e55 `a
erg 04«I
der Lail�nR hjb a,il l�¢q�
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) Q3 , «
.wry-T ._
SIZE OF LOT/PARCEL: square feet %y acres
PROPOSED USE: Residential) (Single-family
i
Multi -family[]) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer ifyou are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: ® square feet (includes the area of the roof/drip line of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES_ NO__>(
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Ener Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, d
others. Check with your Local Permit Officer for more information. ft/p
STATEMENT OF OWNERSHIP: OCT U 4 2024
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of pr e in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development perm , Me person
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
/ an owner or record title, Title is vested in I see Deed Book
page in the , n-1-ati,l"f; 2 County Registry of Deeds. y
_an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)
(2)
(3)
(4)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development s planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu=
lar hazard problems associated with this lot. This explanation was accompanied by recommendations conceming stabiliza-
tion and floodproofing techniques.
I furthermore certify that I 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.
y,
This the
day of -� - , 20
Landowner• or person authorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a check for $100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.

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RECEIVE®
O C T 0 4 200224r
DCM-EC

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: y 1� N
Address of Property:
Nl�
M fling Address of Owner. u 1 rr I e X < )'
Owne email: 6 r-nil .—Owner's Phone#: d n
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
RECEIVED
0 4 2024
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-DONOT 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 (Choose only one
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 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
&rtOwner,
��y O//
TypedlPrinted name of ARPO:
l `o AT
Mailing Address of ARPO:
6A000's Phone#• 7 57 7 23 - 2
ARPO's email: v v-r uc ij 1./ 1w ,•w,
c
Date: 1 a � �2 *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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:
Address of Property: P'
Mailing Address of Owner: I a� Anv d�� �1tr n ,Fv\ M C
.}�-t Lv(rl1SCC�xr � Lc�r F' -71
Owner'suOwner's Phone#: ail: �;t o
Agent's Name:
Agent's Email:
Agent Phone#.
RECEIVED,
0 C T 0 4 2024
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Propertv 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
1. _._ _--. tie ..rnvirluri with this letter.
II-DONOT have objections to this proposal. I DO have objections to this proposal.
if you have objections to what is being proposed, you musr nou y -•- - - -
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
noted by Certified Mail.
WAIVER SECTION (Choose only one)
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 r prap 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 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
TypedlPrinted name of ARPO: /
L19
Mailing Address of ARPO: /a �� �� Sq /74:�� 4�) 19—d
Co 5 93-�O/2-
ARPO's email: � � s cLOwtii'�-ARPO's Phone#: 7 7 7
t �/� � *waiver is valid for up to one year from ARPO's Signature*
Da e.
Revised August 2022
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