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NCAMAI/ �iDREDGE & FILL N? 6271-
GENERAL PERM 11@ Previous permit #
�,New DModification ElComplete Rei Partial Reissue Date previous permit issued
—N
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commissionin an areicif e4v_ironmental concern pursuant to 15A NCAC
LJ Rules attached.
Applicant Name 1 7 Project Location: County )1b,
p
�ddress Ir v H. Street Address/ State Road/ Lot #(s)
"JJ
ZIP,-' \�j 1 k, I State City
�p/U Subdivision
�one Fax-* C ......................
City P
('t-tJ ZI
Autho rized Agent
--.— - !
Affected 0 CW NEW Y�TA DES El PTS Phone # /V River 'Basin(f
DOEA 6'HHF DIH 0 UBA El N/A .
Nr nat man unkn
AEC(s): Adj. Wtr. Body
/)
0 Pwst- DFQ—. (T
Closest Maj. Wtr. Body—
s / o ) PNA yes (,o ORW: ye Crit.Hab. o'
Type of Project/ Activity ^�-, r, 6 l'i 1 7 1--
Pier (dock) length
Platform(s
Finger pier(S) ----------------
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
hannel
In
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
- ing
Other
VShoreline Length
sity
V
SAV: not sure
yes no
Sandbags: not sure
I Moratorium:
yes
n/a
yes
Photos:
Waiver Attached:
yes Ono
Nes no
A building permit may be required by:
Notes/ Special Conditions -1
//-,I, t
ocl
)-x , I , ik
.A'
El See r)ote on
1 (Scale: 0
regarding);Uver Basin rules.
U
22!�
enfdr Ap' cant "PrintecrWaIni-
p
Permit Offices Signature
Signature ase read co p iance statement on back of ��rmit
Ilymaguate
Expiration Date
'
J
cationFee(s)AppliCheck# l
Local PlanningJurisdiction
Rover File Name

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 andvoid.
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 consistentwith 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

Vi a[ " a� --t— {� =2 `I rjj F3z u �� vy � n. �. r''
��`� �Iv7z���aG� �.a ...y��..�`�`��ca �.��' �-j:�Sd� Yi, dl;��,)s��_�'{
Applicant:
Date:
��.� ram- • � � ��.
l
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Apply d for.
Disturbance• total
includes any
anticipated
restoration or
temp im a
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
im act nt
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impactsimpactsV
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
clow
-Wo
redge ❑ Fill ❑ Both ❑ Otherlg-
/ K
-, /— r—
edge Fill❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both' ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ . Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other OF
i
revised. 02JO3110
j

.AU�Gmw3a
ZG p 9(ld N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date S• 2 t/
y
Name of Property Owner Applying for Permit:
Mailing Address:
i Z
I certify that I have authorized (agent) e- kt-T 0!7! - i✓� Ito act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) rBU a "4-p i
at (my property located at) 2C 2=C>L.-• 0or , ��� 1'YI �1<• �!. � .
This certification is valid thru (date)
-2- l
P erty Owner Signature Date : _-

2013-05-25 15:20 Grimes Plantation 2524130373 >>
P 1/1
ADJACENT RIPARIAN pgopcgTy OWNER STAIMENT
11f
I hereby ce* that I own pmpwty 0400ent to
(Name of Propeety Owned
property located at r u
(Addrsps, Block. Road, air-) N.C.
on n'-�' `� !n (ItylTown andlor County}
(Wa4drbpdy)
The applicdnt has db KdAd to Me. as shown below, the davebprnent Proper at the above
bk I hmM no objeWon to this propossl.
I have objections to this propastml
DESCRIPTION ANDIOR DRAYM43 OF PROPOSED DEVELOPMENT
pndyvl W PmPO&O d*vekW~ t must Rll 1n dega: 4Ww below or attaab a SHO throwing)
6'
c
-KW. rrA* �.0 't)0+1+'S
►tS'�AU mil ►.g� �� 1>s `/ / . i
I undenrtand OWa°pier dock, mootin8rbosthouaf�' or groin must bo eat
of
back a minimum distance of I & from my ar+�i rlpa In acodad �i'� by ma. (if you
wish to waive the s•tbadk, you must Initlsl the rflpproped& blank below.)
do with to waive the 15 setback requirement
1 do not wish to waived* 16 setback requirement
(props t OM
r IMonnatlon) {A Int *ty Owner Information)
Sit,e Sig e
Punt or Type Ne►n+
I IZ I'p rpt Ot �n i
Mai Addiesa
0
TelspWw Number , v
Date
7Si13 A-73 f19.4n COASTAL CAROLIN 2524470125
Data
(Rre umW &1&2012)
Parte 2/2

MjEaRIAN p.ROEERTY OMER UAMKK
tto tt
`s
!hereby oectify that I town property sdj2�n ._:F-
(Narne of Property Owner)
property iO AW at i --- �= car rt DaL L'i "
(Addreaa, Lacy Block, road, etac•)
on T K , in d kh-- M N.C.
(1Afa6erbody) (City/Town ,andfor County
The applicant has described to me, as shown Wows the development proposed at the above
location.
\,.v-5 . t have no objection to this proposal.
a • • _ of • • 1 tl • f • { " : F
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
t7netfvidad prvposfnq deve topmwd must w in desedpoon below or attach a sfte drag MW
e-►c►
ti
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i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must beset
back a minimum distance of IV from my am of riparian access unless waived by me. (if you
wish to waive the setback, you must initial the appropriate blank below.)
Lc-�� I do wish to waive the 1b' smock requlrement.
I do not wish to waive the IV setback requirement.
(Property a er Information)
Frfnt`ar Type
Ades
Tekph*V der
'S • 71. t'%
=11 —A
e
Telep e Nynber
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(Raves $1820 4