Clark, William

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I CAMA / El DREDGE & FILL
GENERAL `PERMIT n t K Previous permit #
vNew ` o ification ❑Co plete Reissue ❑Partial Reissue Date previous permit issued
As authorized by t e Sta�i C'�[fol)na, epartment of Environment and Natural Resources i
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
i
Rules attached.
licant Name '• + 1 �. .,j.. € i.'" } ; `4—
App fi Project Location: County
Address _ ' I --I Street Address/ State Road/ Lot #(s)
ty State ?� ZIP '� - j 1 j i r J.
,Phone # (N) r" i�-, �— Fax #{- -j Subdivision l
Authorized Agent
1 i " ; ,'
ji .
City
Affected ❑ CW
El PTA
ElES ❑ PTS
Phone # ( i r):`.
AEC(s): ❑ OEA
ElHHF ❑ IH
❑ UBA ❑ N/A
Adj. Wtr. Body
El PWS:
f
❑ FC:
' 1
Closest Maj. Wtr. Body
ORW: yes / no
PNA yes / no
CritiHab,—yes_ ..no_._..
Type of Project/ Activity'
1--
�I`'
Pier (dock) length,,,},
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other 1 �r"l , (;
C�j,� t.:,o
Shoreline Length
SAV: not sure
yes
no
Sandbags: not sure
yes
no .
Moratorium: n/a
yes
no
Photos:
y-1es
no
Waiver Attached:
•', a
no
ZIP
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A building permit maybe regwre�dby: ,, \ l ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions r 1 -J n . Jh 1A,tV ! , ,rig: /(��_ . r�x, )lr:;-!fx f
Agent or Applicant Printed N� PermitOfficer s Signature
Signature 71 Please read compliance statement on p * Is{suing Date /, Expiration Date
'Application Fee(s) L Check # Local Planning jurisdiction ! 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 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, certifythatthis 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 comply with 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/ 1-888ARCOAST
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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 06- 1
Name /of Property Owner' Applying for Permit: 1
/
Mailing Address: �-^
�aX �1g q
%rd crC3 yc. a 7 IV
I certify that I have authorized (agent) 1 I 1 �i5 to act on Inv
behalf, for the purpose of applying for and obtaining alljCAti1A Permits necessary to
install or construct (activity)
at (my property located at) ji l tJ�
This certification is valid thru (date)
!/
Property Owner Signature
4` /SA
Date
RECEIVED
OCT 15 2014
-)rM-M;F D C►1Y

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ADJACENT RIPARIAN PROPERTY 1OWNER STATEMENT
I hereby certify that I own property adjacent to W%�1�*+ ��fl✓y G%r�
(Name of Property Owner)
property located at I301 1 /c-4-<Irlela- 1 - ,, L ,f /vG "2 35��
-lam C1� (Address,
in
(Waterbody)
and/or County)
The applicant has described to me, as shown below, the development proposed at the
location
i have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site draw;
5
pi
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.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requi ement.
11 '&4
(Property Owner Information)
lax 1 C r' /-e
Signature
Print or Type Name
f?a. L� //S-T
Mailing Address
l g1"io/c' Vc- %gg-.L
QtVVStat&7ip
- -f/�3 — B!!�2—
Teleppone Number/email address
/0//.1/l,;f
Date
'Valid for one calendar year after signature
r
pis
1
s ty C/ St (;J
phi umb r/email address
Date*
(Revised Aug. 2014)
RECEIVED
F
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.... .......... ..................... .................

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �& ez-6OR.%1 'S . I Lf1 V p 's
(Name of Property Owner)
property located at 1 -501 F20N,T `:>1rQea-r
(Address, Lot, Block, Road, etc.)
on -- 4Y/L.o 4,6 449E /L, , in BSA U FONT , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat
_- I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
6 Eg- *47-mcm-ei">
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
�C I do wish to waive the 15' setback requirement. I o 131i'� SPD M-(,
I do not wish to waive the 15' setback requirement.etc VJCA oZ{
(Pro erty Owner Information) ( cent Properly _caner In ation)
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Sigpalurdv I Si tat re
Aeey OP--4 6 • L (2121LA41 D I'-t-L[12a4 141 LL (.EWI 5
Print or Type Name Print or Type Name
10 2'B W AT�Vh R-1"�- � 3 S T1 F1=guy L4M Y RECEIVED
A�tl� g Address Mailing Address
l:+tE�AflEAXG3VA 2-aa _$974Mr0AT. Ale, Z$5142
temp -/ City/staterLip n .' OCT 1 :� 1014
7' 43� 34v t7 Z5 2 �- ?.�� — O 72Z DCM-,UHD CITY
Telephone NNurgber Telephone Number
Date / Date REMED
jUIVef0 LUIF012)
DCM-MILD CrM

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RECEIVED
OCT 1 r, 7w
DCM-MHD CITY

13:11
17
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RECEIVED
C6 rfe,hf OCT 16 2014
/, DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A//&&cm I- rf���y G/cry' 's
(Name of Property Owner)
property located at 1301 Fo4 S/r�� A3�srv,��� ,f/G o2 SS'/-/
-r (Address, Lot, Block, Road, etc.)
on la illae CICek , in ,Ag"VA - , 'VC , N.C.
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
/7
5
3
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.)
b" I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback
(Property Owner Information)
Signature
Print or Type Name
Ao. �,,� //19
Mailing Address
Trv.o/'o
C^— it �/State2ip
— 0 — e//a-
Telep one Number/ email address
/0 /a-//cf
Date
*Valid for one calendar year after signature*
I.wim
'I RECEIVED
!
OCT 16 7A14
lb/epll1(uirrj6ter/email address
Date* ttjj `*
(Revised Aug. 2014)
DCM-MHD CITY

I hereby certify that I own property adjacent to s
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (City/rown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
12
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of I & from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must4niitial the appropriate blank below.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 1 & setback requirement
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StataOp
Telephone Number
Date
Print or Type
Mailing Address-.
I-
citylstATO
f6le
Telephon -Nu f,,�Iw�1-
Date �(
(Revised 611 &2012)