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GENERAL PERMIT Previous permit #
Al
W.PqNew ElModification OComplete Reissue OPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name EXProject Location: County
Address Street Address/ State Road/ Lot #(s)
City-1
ONE,
State ZIP 77
,'
Phone # •E-Maill
4.
I&IJklivision
Authorized Agent
e')
City
ZIP
[I CW
Affected ❑
bEW Q PTA ❑ ES
., 1 11
0 FTS
Phone
River Basin
0 OEA
AEC(s):
0 HHF
El lH 0 UBA
El N/A
Adj. Wt y
r. Body
nat km4n,-Lunkn)
El PWS:
ORW: yes /,no
PNA
yes 1; no
Closest Maj. Wtr. Body—
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s).-
Groin length
number
Bulkhead/ Riprap length
ayg distance offshore
maxdistance offshore
Basin, channel
cubic yards
Boat ramp t
Boathous6/ Boatlift
Beach Bu 90n
Other t
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes n:
Photos: yes,
Waiver Attached: yes n
A building permit may be required by:
Note Local Planning jurisdiction),'. .
Notes/ pecial Conditions
Ag
ent or App icanf
J;i
I N-
amsP
: 1k -I -I' 1;
Al See note on back regarding River
'X
o ).J
-ad comp
liance on back of permit
~: F" L . ae
Permit Officers Printed Narile
Signature
,asin rules.
App!icationFqe(s) Check#
Expiration Date

r
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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar -Pamlico River Basin Buffer Rules 0 Other:
EJ 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastalmanagement.net/
Revised 08/27/ 14

'a.
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: L)1eZ-AoeN
Mailing address:
Telephone Number:
2 S �? —,36 )-- S'y z 0
I certify that I have authorized (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of I---- "g � 2a /`� rT
at my property located at '%6
This certification is valid through / z -- -3 /# / S— (date).
-RECEIVED
(Property Owner Information)
" Sigftture
-1)wol
Print or Type Name
Title, co. owner or trustee for property
Date
2SZ— 3sot-5 i , �-6
Telephone Number
l• �' ZAP r aJ P J . N %1 e
Email A dress
NOV 0 4 2015
DCM- WHD CITY
RECEIVED
NOV 17 2015

x
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to '✓e ✓� A 1. L it ii/e A 's
(Name of Property Owner)
property located at ,
T
/�
(Address, Lot, Block,, (Road, etc.)
on 61?� e 6?vie e in /`r,CD0,2 N.C.
(Waterbody) (City/Town and/or, County)
Agent's Name #: Mailing Address:
Agent's phone #:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRiPT10N AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
rlc� ��,J ��Tlj.c�✓�� �r� �o�-% RECEIVEDFc �C�I�E®
NOV 0 4 2015
DCM- MHD CITY
If you have objections to what Is being proposed, you must notify the Division of Coastal Management
(DCM) In writing within 90 days of receipt of this notice. Contact information for DCM offices Is
available at httn://www.nccoasta/management.neVweb/cm/staff-listing orby calling 9-888-4RCOAST.
No response Is considered the same as no objection if you have been notified by Certified Mail.
3k /- L7 90
Telephone Numberl Email Address
Date
—7-7 & Se.QC-5-a& Or _
Mailing Address —®C M-
ftAu o,-4- JkJC Z8'5-70
City/Sfate2i1
2SZ 8©p,--Rag(
Telephone Number/Email Address
/0— 22,-15
Date
(Riparian Property Owner Information)
�2
Sign to RECEIVE
Print or Type Name Nnv 17 )
(Revised: Aug. 2014)

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to I)oV11 34 ZZAIC11 's
�// (Name of Property Owner)
property located at `% fa trr �/��,4 ( -/, 6R
// (Address, Lot, Block, Road, etc.)
on LdRie- le.,g-E L in ApulAee L N.C.
—r
(Waterbody) (City/Town and/or County)
Agent's Name #: Mailing Address:
Agent's phone #:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
e- t �h kT /t e7- 9 0C rows e- .0 �'A 4 .`T 44 /c . REC
410111EIVED
NOV 0 4 2015
bCM- MHD Cl r
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) In writing within 90 days of receipt of this notice. Contact Information for DCM offices is
avallable athp://www.nccoastalmanaaement.nei/weti/cm/stafflistinq orby calling 9-888.4RCOAST.
No response is considered the some as no objection if You have been notified by Certified Mail.
(Property Owner Infornlatiipn)
Signaturl
Print orType Name
Madin Address
k0tv 00,2 AhL
Cfty/State/Zip
Z-�-2- 34,/- S a_0
Telephone Number/Email Address
/0 2 Z
Date
(RI ian ert ner Information)
i
Signature
Print or Type Name RECEIVED
7'e6 5 Fg- Gil �� NOV 17 2015
Mailing Address
'19 ew re x r �r� r �►r�I,'® M H D CITY
City/State/Zip
2-5-- - 72-3 - 2 2- z3—
Telephone Number/Email Address
16 Z
Date
(Revised: Aug. 2014)