78771A_Zach Myers_20201022

❑ CAMA / 'E DREDGE & FILL ND 78771 A B� C D
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
Nand the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC . oO '9SC+U�V�IVIVX>gI4��
YRules attached.
Applicant Name
Z Ck C i�t Project Location: County D CL ✓e—
Address `1 �.t.17 V U C GVIv
City ^�-ewb -T�wh state zlP 25L41
Phone # (1D3) 3 R!j- 3l61 E-Mail
W
Authorized Agents D* F j B uJ*_ JAp a i S
Affected ❑ CW (E )(PTA )(ES )f PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes /
Street Address/ State Road/ Lot #(s) 4 j 1 �5 7�0j. yVQ,,V(
Subdivision
city Kl-i ti 1-jC1.wK- ZIP 2 '9
Phone # River Basin Pa 0 }4+A �_
Adj. Wtr. Body C o-vi aA (nat m—an unkn)
Closest Maj. Wtr. Body A l b,-y►^ C[-v 1! 6ou,-1
Type of Project/ Activity .�.y �j �- o V Y' Q C W Q ✓ ,+- iJ IAA. - Ke a
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhea Riprap length 8 51
avg distance offshore l 2 1
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boat
Beach Bulldozing
Other
Shoreline Length # ?S 2),
SAV: not sure yes
Moratorium: a yes no
Photos: es no �._.
Waiver Attached: Lnes no
A building permit may be required by: Dave- C 6 ► 4, ✓vE 4
( Note Local Planning Jurisdiction)
dotes 'Special Conditions ?C I 1 tit Q O� fi v wL
Printed Name
(Scale: N -re-D
❑ See note on back regarding River Basin rules.
5a vGL1� L u A
Permit Officer's Printed Name
Signature "Please read compliance statement on back of permit
gw� VUWAM "400. 0� 0';U-)
Application Fee(s) Check #
Signature
Lu 1 �2 20 2,122 2
Issuing D e 1 Expirat n Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888-4RCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date --V ` Z O ----
Name of Pronnperty Oaner.Appl" for Permit:
lk
Dfailing Address:
g Dv 1 kkraJs
to act on my
I certify that I have authorized (agent)
A
behalf, for the purpose of applying for and obtaining AR CAMA Permits necessary to
install or construct (activity) Ale W 61A � � r�
�j r tf-t11
J v
at (my property located at) q % t * l — % nl t° km y �� �t � ��
. Z.
T%U certification is valid thru (date)
Propc�t/vraa signature
y. v
Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFI or ON/HANDIEENERED
CERFORM
TIFIED MAIL - RETURN RECEIET RE
c^ LC'_-� - -----
Name of Property Owner: , ____-------
Address of Property: A k I
(Lot or Street #, Street or oad, City & County)
Agents Name #:
Agent's phone #:
Mailing Address: vi-- _ L4 -- ��
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 draWna with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
tf you have objections to what is being proposed, you must notify the Division of Coastal Management
(DC" 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 (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
1 understand that a 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. (if you wish to waive the setback, you must initial the appropriate blank below.)
L--"-- I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
'�
Sf,�nature--------------
�
Print or Type Narhe
t-
Mailing Address
City/State/Zip
Telephone Number/ Email A dr ss
to
(Adjacent Property Owner Information)
Signature*
Print or Type Name
Mailing Address
Cdy/Stat ip
--------------------------- -------
Telephone Number / Email Address
--& / / ` --
Date
Da
*Valid for one calendar year after signatureRevised Jan. 2017*

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL, . RETURN RECEIPT REQUESTED or HAND DELIVERED
Name at Property Owner: C _ n ju _-_____---------
1
Agent's Name *:
Agent's phone *:
Mailing Address:
t 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 descriotin or drawlm with dimensions. must be provided with this fetter.
f 0
# you have objections to what is being proposed, you must notify the Wrision 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 (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a 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. (if you wish to waive the setback, you must initial the appropriate blank below.)
�.� do wish to waive the 15' setback requirement
I do not wish to waive the 15 setback requirement
(Property Owner Information)
a�ure
Print or Type Narr�
Mading Address
Crty/StatelZip ----
Telephone Number / Ernal! Address
/0'z! Z
Zl1 y
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
--------�.- ----------
Signature;LIV
ate Jy—_---
Print or Type Name
Mailing Address
N C, 285 C)L_-_i
C/tylStatelZip w -
Telephone Nt;nber / Email Address
10 I'�, 12c
Date;
Revised Jan. 20i 7

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This map is prepared
from data used for the
inventory of the real
property for tax
purposes. Primary
14.
4113 Pineway DR
Kitty Hawk NC, 27949
1
v
Tax District: Kitty Hawk
Subdivision: Kitty Hawk Landing Sec 3
Lot BLK-Sec: Lot: 53 BIk: Sec: 3