Dodd, Lawrence

�,CAIVIA /11DREDGE & FILL A B D
GENERAL PERMIT Previous permit #
New ElModification El Complete Reissue ElPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources 114-
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �j attached. El Rule
A Lt
Applicant Name Project Location: County_(
Address Street Address/ State Road/ Lot #(s)
City State L-1
Phone # SO I /E-Mail k I Lk hy"'I Subdivision -
Authorized Agent X�. city ZIP
A"
Affected 0 CW 'PTA ES 0 PTS t2 ,E Phone # River Basin [D OEA 0 HHF 011H f 0 USA 0 N/A
AEC(s): Adj. Wtr. Body, naV an,16nkn)
0 Pws:
es Closest Maj. Wtr. Body A
ORW: y no PNA yes/
(0,
Type of P roject/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)____
Groin length
.--;number
Iqulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing ......
Other
Shoreline Length
SAV. not sure
yes
n!
q�o-
Moratorium: n/a
yes
(n
Photos:
yes
( no
Waiver Attached:
yes
no
A building permit may be required by:
( Note Local Planning Jurisdiction.
Notes/ Special Condit!
(Scale:
U %.0 11VI — 11VI 11 U U I I '
See note on back regarding River Bas
NJ I k
k-J
t /
Agent or Applicant Printed Name
t
Signature Please read c6mpliance statement on back of permit
C1
Application Fee(s) Check ,#
rules.
PermitOfficer's Printed Name
Signature.'.
Issuing Date Expiration bate

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, certify that this project is consistent with 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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.nccoastaimanagement.net/
Revised 08/27/14

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit:
A- -An 0 /1 6k-1-4 C,
Mailing; address: COLIC-- GT
Telephone Number: q 1
6cri-ap— &vt4 nl �G�rm
certify that I have authorized /u (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits:
necessary forthe'proposed development of b ei ika_
at my property located at
This certification is valid through (date).
(Property Owner Information)
Signature:
Ac­%ewe Ds�p
Print or Type; Name
_1,1//4 d LL
f� �
Title, co. own r or rustee for property
Date: _ _
9/1SF/C/ �
Telephone Number
Email Addres
RECEIVED
DEC 14 2015
DCM- MHD CITY
RECEIVED
DEC 16 2015
D C M N-1F>f � -- F-r

Apiamgipmm PRouglY OWNER STATEMENT
I hereby certify that I own property adjacent to X44wl0ler 12OL t 1,A- LGG 's
ame of Property Owner)
property located at 2'S &4 t/io'ea fJ!r/
(Address, Lot, Block. Road, etc.)
on ¢_ ouh in A-�/�tnhL :Ae , N.C.
(Waterbody) (CityITown and/or County)
The applicant has described to me, as shownbelow, the development proposed at the above
location.
! I have no objection to this proposal.
I have objections to this proposal.
#
'DESCRIPTION ACID/OR*DRAMINO OF PROPOSED DEVELOPMENT
(lgdividuaJ prvposing devetoptiienf must frlfln, description below oradach iaq, drewltrgj
/vCwIl OV Zt/I hvu �f�
RECEIVED
y
DEC 16 2015.
t
DCM- NIHD.'CITY
r
RE EQ ED
7
DEC 14 2015
WAIVER SECTION
I understand that. a pfier, clock, mooring pflings ;boat rainp,.breakwater boathouse, Ifi M H D CITY
mud.W sef backmin'unum idistance of 1V from my:area of riparian access unless i
;.
_a
m . (If you wish to walve`ihe setback, you must initial the appropriate blank befoyi)
,mCoffdo wish to waive the W setback requirement:
I do not wish to waf ve the 15' setback requirement.
(Property Owner inf tion} (Ad ceirt Property er ltrf . _ on) '
y
r ''
Signature S" a-V rZOAC
P t or` Type Name
V O`
ict_ t
TaYap W her/e aN addrpss Telephone Nr rl address
C06*n '2
Date Date'
2—)'tc7� t
!`
/ (Revised Aug. 2014)
wand for one calendar year after signature

ADJACENT RIPARIAN PROPERTY Q---,A/WEMZ ST..ATEFIBEiti i'
1 hereby certify that lows property adjacentTo _ A�-� � b 1 L�-L- is
{nlame of Pro- ►y OrvneY)
property located at ��_�ay1 r�>�dG� _
Md.dress, i_ot,'Bloc;c, Road, etc.) -
(Uilaterbody) (-.Ky/t own'.nd(or County)
The applicant has described to me, as shown below, the developmant proposed at the'above
tocation.i
1 have no objection to this proposal
I have objections to this proposal.
- DESCRIP T ION AND/OR DRAWING OF PROPOSED DEVELOPME.N T
(individual proposing development must fill it derscr-lpt: ,; tJelot^r or attach a site drawing)
lvaz-i
00A,
RECEIVED
DEC 14 2015
DCM- MHD CITY
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 setbad., you must Initial the appropriate blank below.) RECEIVED
.. J1 do wish to waive the '15' setback requirement. DEC 16 2015
i do notwish to waive the 15' setback requirement..
.�. - ..�n;... 1 H D CITY
(Property 0 r cormeLlon) (r� " }�'-'ro eri,� vine matio
Si satzrre S anal , C
ill-w/pw6e
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,� Lake< 83 l o
c, ,vi 8ler�a l
Telephone dumb rl email address
�1 �, i Sr
Dare
1, 2—1 1� I r 5- (Revised Aug. 2014)
*V611d for one calendar year aiter signature'