Edwards, Rex

.'I�1CAMA /,7 DREDGE & FILL
GENERAL PERMIT
Previous permit#
INNew ❑Modification ❑Complete Reissue ❑Partial 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
Applicant Name w , , s : r,
�4pp 1� '�`, � r � '�`� ��� �
Project Location:
Rules attached.
: t i': L
County i � .-� � (=��
Address I lt'`>.• J ; 3: ;
Street Address/ State Road/ Lot #(s)
City 4� # � 1 "i t i �, State �.�._ ZIP -,
Phone # ( f-) ` ` `�-* Fax #
Authorized Agent ;`;=
❑ CW .Q EW M PTA � ES ,p PTS i
Affected AEC(s): ElOEA ElHHF ElIH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA• yes F! o Crit.Hab. yes //i o
Type of Project/ Activity
C s
Pier (dock) length
Platforms)
Finger pier(s)
Groin length
.,, nur ber '
ry Bulkkh_adjAprap length
avg distance offshore-12�
max distance offshore_
Basin; channel
cubic yards��
i
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
J'
`r
Shoreline Length
SAM not sure
yes o
Sandbags: not sure
yes no
Moratorium: n/a
yes no
;,Photos:
yes no
Waiver Attached:
yes no
A building permit may be require!
Notes/ Special Conditions 1
,` \ O(V,
Subdivision
City. ZIP
Phone # ( ) �,',, , ,i... h'
River Basin �_. �•�.
Adj. Wtr. Body (nat (mari�/unkn)
Closest Maj. Wtr. Body .- ` ot�
t (Scaler 1J )
�"
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NNIMMEMEMEMEi■eiM:=
REMS
as
NEEMENEEMEN
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by: i f i (' k i) I I 1 r1
❑ See note on back regarding River Basin rules.
11 J i
('Agent or Applicani Printed Name Per it Officer's Signature %
Signature ** Please read compliance statement on back of permit* Issuing Date f, Expiration Date ..
ApplicationFee(s) 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 I) 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/ 1-888-4RCOAST
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 Zlo . '1
Name of Property Owner Applying for Permit:
f-4�:-v GT Lz A- r- D'�-
Mailing Address:
D4 E(—ry, o LrQ )
,PKS jq. �. 2-8-)rZ
I certify that I have authorized (agent) M Li 0 i� v C, kiT to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 5C-4,-' 4 0 f)2 UGC" S' 'I? ,
at (my property located at) 1 O'P TZL" e-. -
This certification is valid thru (qat�e)
Property Owner Signature
Date
RECEIVED
NnV 19 2n14
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that 1 own property adjacent to FAX E D 'Aj
j 's
(Name of Property Owner)
property located at O EL- y?i
� � (Address, Lot, lock oad, etc.)
on , in , N.C.
(Waterbody) (City/Town and/or County)
The.applicant has described to me, as shown below, the development proposed at the above
location.
Y- - 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)
04
RECEIVED
Nnv 19 2014
WAIVER SECTION DCM-MHD CITY
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.)
I do wish to waive the 15' setback requirement.
Z-.
do ` not wish to waive the 15. setback requirement.
(Pro rty wrier ion) (A ' cent Property Owner Information)
STev
ature e
E 11elfs �Q
Print or Ty a Name Print or Type Na e
l� ter^ �01-,�-
! mg�A�ldress M ' ing Ad res stxvp l I
City1S< /Zip D City/State/Zi Joe,
Tee pho ? er Tel one N b i
Xof
Date Da e
(Revised 6/18,,2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 7-,A' Lk.,'-f'`12 S 's
(Name of Property Owner)
property located at ( O�--�^'� Co
(Address, Lot, Block, Road, etc.)
on in lC -S , N.C.
(Waterbody) (City/Town 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.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawling)
ISM 2� 3=`lam-'Z') '33c��A3
Ar ,L' 1�v d L,
RECEIVED
NOV 19 2014
WAIVER SECTION DCM-MHD CITY
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.)
I. do wish to waive the 15' setback requirement.
I do not Xish to waive the 15' setback requirement.
(Pr fer!yP�for ration) (Adjace r rty owner Information)
w
S' nature
Sign
Print or Type Name �.,
Prin
r T e
j
l'aq CLwt Z-0 1 A-►
m
T
Mai1i gyA5 ess .C -
Mailin
City/ tate/Zip
C-59 2�S'3
City/
tatem
6
l
p 1
Tele�phon Nu ber
Telephone eVl;r
4
V
Date
Date
(Revised 6/18.,2092)