Daugherty III, William

L 1CAMA / ❑ DREDGE & FILL
A
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B`G D
GENERAL PERMIT
t perm#
�7New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and
Natural Resources _ / ' ..,-
b i
and the Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC .
❑ Rules attached.
Applicant Name
Project Location: County i .=
Address `' ! (• e ; ,. -�
Street Address/ State Road/ Lot #(s)
City r "{ y ;'� State cif ZIP
Phone # r'(�E-Mail
Subdivision
� j ;
Authorized Agent t i t c ;� j .: ,, , , - ` ,/
f
City `J t; . �, ZIP
r % 1
Affected ❑ CW -DEW _0 PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
AECs:
()
Ad'r ' ' ` / i r ' k
1. Wtr. Body (
f�
Oat :/man /unkn)
❑ PWS
ORW yes / no ` PNA yes / : no''
Closest Maj. Wtr. Body
Agentor Applicant Printed Name
Signature ~* Please read compliance statement on back of permit **
Application Fee(s) Check #
PermitOfficer's Printed Name
Signature ` ?'
I JIr �•+I ..- `mil � t ``/`
Issuing Date Expiration 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, 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 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
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
•
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor . Director
Date
Applicant Name
Mailing Address
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) 61w Wad' to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
44V GXzO M';Al ek , /b)rzo T+eL. 2 at (location)
q00 Sea Cart oO ijL o-W /1i—wa...6/
This certification is valid thru te) — 3/— /
Signature
V V
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
RECEIVED
DEC 16 2014
DGM-MHB CITY
RECEIVED
DEC d 11014
DCK4-MHD CITY
NorthCarolina
Natura!!r�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent towTLZAA F. haoe/fAru x,s
(Name of Property Owner
property located at 10 0 SJEA GAr�
(Lot, Block, Road, etc.)
on TC W. . _ , in W w M87-
(Waterbody) (Town and/or County)
Applicant's phone #� �� T7�"�9Qq Mailing Address: krjo Gila cr Rlh
NE id 41 &A N _ Ar. c -1-900
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
1�t4 ut- ,
Mailing Address
'kJ4Uf -� -t r ,d -
City/State/Zip
,�Z,f z.. t6-7 y. -"-9q
Telephone Number
ttj-,�-4 . z2�,fk�
Signature Date
O
I 4b
i
RECEIVED
DEC 16
(Riparian Property Owner Info a ` n)
Signature
V, L.)) �X)
Print or Type Name
�i•o 3 � �`� $+ � a g o
Telephone Number
If 25 -- 2 ol'A-
RECEIVED
Date
DEC 01 1014
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1,9m jQv 1r--�(q1 's
(Name of Pro ert ( wner)
- - - property-. located -at - 706 s�A tfi�T� 4P
(Address, Lot, Block, Road, etc.)
on CAI , in c- Iye01b)? r , N.C.
(Waterbody) (City/Town and/or County)
y�4
fcU The applicant has described to me, as shown below, the development proposed at the above
location
pya- _ I 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)
/Ll
O O
/oxZ�
RECEIVED
x DEC 16 7014.
DEh1-MM9 eliY
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.)
do wish to waive the 15' setback requirement.
do .not wish to waive the 15' setback requirement.
(Property Owner Information) (Adj
1if l :may �`
Signature, - rf S,
You Gt/.�� �Ze n �
v
Information)