Cox, Lee

C1yCAMA / C9 DREDGE & FILL
GENERAL PERMIT Previous permit#
DNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources l
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ! �/ . �1 -'i J
.. ... ..„ ,ww. _. Q Rules
Applicant Name t` r ( Project Location: County
{Address Street Address/ State Road/ Lot #(s)
ity i t ��I��r. + t; f''�° State Hk-- ZIP F
hone # ('i�) i� i'' - Fax # (_
,uthorized Agent tV ; z 1 ; t ^ � z'
Affected ❑ Cw © EW rd PTA 0 ES v ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body `� r i 4 (i 7 ( (nat /man%/unkn)
ORW: yes / no' PNA yes (no Crit.Hab. yes /ono % Closest Mal. vvtr. Body f { •� j / 'L'
T ype of Project/ Activity
Pier (dock) length
Finger pier(s)
Groin length
_number f
Bulkhead/ Riprap length ( �,
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathous%Boatlift ! :' I
Beach Bulldozing '~
Otherl i
- _
;Shoreline Length
,,.
f -)
SAV: not sure
yes in -
Sandbags: not sure
yes `no-
Moratorium: n/a
yes (no
;Photos:
yes no
Waiver Attached:
yes ` no
may',
A building permit may be required by:
Notes/ Special Conditions !"'t-t
.E
r
(Scale:
mmmm i mmmm
R®®r®M®® ENEWE■■s®
1 �
❑ See note on back regarding River Basin rules.
�: -f�
/
r Agent or'Applicant Printed Name Permit Officer's Signature r
Signature * Please read compliance statement on back of permit Issuing Date Expiration Date
Application Fee(s) Check # Local Planning,lurisdiction . 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
❑ Neuse River Basin Buffer Rules
Other:
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/ 1-8884RCOAST
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 ) 0' 2 6' d y
Name of Property Owner Applying for Permit:
Lc- e- Lod
Mailing Address:
I certify that I have authorized (agent) i%1 L, p f3,- t 1L7rT2eJ5r ti4 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
RECEIVED
Nnv 19 1014
This certification is valid thru (date) r j Z S DeM-MHO cm'
/0 /,2-� /Zoly
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to Le - L©� is
(Name of Property Owner)
property located at a(a Ur ti «_AS
(Address Lo Block Road etc..)
on ,in FK� N •C, Zzs tz
, N.C.
(Waterbody)
(City/Town and/or County)
The_,:applica t has described_ to me, as shown below, the development proposed at the above
locatio - .
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)
8u-o
Ga w-.Q LI
V
r
0
b
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back aminimum distance of 15' from my area of I riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
RECENED
I do wish to waive the 15' setback. requirement. N(1V 191014
I do not. wish to waive the 15' setback requirement. oeWMI-1e errr
(Property Owner Information) (Adja nt Property Own r formation)
6(le
Si ature
Print or Type Name
-1 U (a AS
Meiling Address
(.ne.' Jc�„11 knieh A& 2RSI�
Cit /State/Zip
Gt� t9 1� ZSO(.
Telephone Number
0 Zh� �OfN
Date
Simon lure .
Print or�T Pe N m
Maili � Aess
City/State/Zip
Z l
Telephone Number
Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that 1 own property adjacent to (_._�1z'4-o yC s
(Name of Property Owner)
property located at
(Address, Lot,pock,_Road,`etc.
on � a tiaL in lLZ�S12
N.C.
(Waterbody) (City/Town and/or County)
The, applicant has described to me, as shown below, the development proposed at the above -
cation.
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)
� e
9 I �CnWJal j
DJc1t ,
WAIVER SECTION'`
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back aminimum 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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Inf rmation) (Adjacent Prope ner Information)
S'ignature t e
La Ve
Print or Type Name Print Type Nanfe
9 ( ,Ac i, Lov.,f '96I13 6 1/iew Drive
M fling Address M ' ing Addre RECEIVED
;�� IL�uiI S kor s , �C 2L512. „r4c.,E&.vUG 277/�
Cily/State/Ziip' 2 O �o City/State1z NnV 19 ZQt4
�--��'' l g �1 � �1 � �� ACM-MHD CITY
Telephone Number Telephon Numb ZI
Date Date