Eshleman, Martin

CAMA /❑ DREDGE & FILL.`
V 8
GENERAL PERMIT
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Previous permit#
(New ❑Modification El Complete Reissue ❑Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
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and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
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s © Rules attached.
County !
Applicant /� ! I f 1 { 1:
Project Location:
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Address - +' 1; f i jl �' + ,c ,1 �- - ti
Street Address/
State Road/ Lot #(s)
t
City 1? ` 1 �:i`ti; ;" Stater ZIP
Phone # "`+ J/j E-Mail
Subdivision
Authorized Agent f s{; i i g t f�/"'. 1 i( f /1
City
f f ZIP----
CVi/ ' eW " m PTA : pEs 6 FATS
Phone # (
) /� / River Basin
�' "r
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
Adj. Wtr. Body
� � -fi % %' ' ` [ ` `` . (nat- /man /unkn)
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((
Closest Maj. Wtr. Body
ORW: yes / �no PNA yes / :no'
Type of Project/ Activity
(Scale: `:' t,)
Pier -
Fixe
Float
Fing
Groi
1 .Bulk
Basil
Boat
Boat
Beac
OthP
Shor
SAY
Mor
Phoi
Wai,
)I
!ngPlratform"(s)�,Nm
IMMMEM
ME
ON
MENOMONEE
le h
Moo=
number
avg distance offshore_
MMEMME
ME
MEN
max distance offshore
0
ELI
MENEEMENEMMEMMM
,channel
MIMM
IMIMMIN
MEMO
cubic yards
ramp
No
MEN
mom
MENEIMMMEM
0
MEME
N
MINUME
0
MMEMU
,,Bulldozing
MEN
ME
MEMMEMMUSEMEMMEME
MEMENNE
ME
ENNE
'a
EMENNEEMOMMEMMIMIMMM
ME
ONE
0
OEM
M
M
ME
NEEMOMMINEEME
MEN
MOEN
IN
not sure yes no
mom
mom
ONEENEEMNSIMMENE—
,MEN
yes no
IMINIM
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
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Agent or Applicant Printed Name
Signa pre * Please read compliance statement on back of permit
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Application Fee(s) Check#
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❑ See note on back regarding River Basin rules.
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PermitOfficer s Printed Name
Signature
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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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888-4RCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the cans to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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bar{VC
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2. Article Number
(Transfer from service IabeO
PS Form 3811, July 2013
A. M/C
X �f Agent -
❑ Addressee.
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from Hem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mall® ❑ Priority Mail Express'"
17 Registered ❑ Return Receipt for Merchandise
❑ Insured Mail 0 Collect on Delivery
4. Restricted Delivery? (Extra Fee) -__ ❑ Yes
7014 2120 0004 6890 3744
Domestic Return Receipt

UNITED STATESPP Tom$ JICE First -Class Mail
Postage & Fees Paid
USPS
20 MAY .'15, Permit No. G-10
• Sende`r:`Please print your name, address, and ZIP+4® in this box*
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to rn �� i 0'i �S '1m 1� i~ 1 's
(Name of Property Owner)
property located at 143Z _70 01 o y-i
(Address, Lo , Block, Road etc.)
on PI - 1'1 CrLe:T51L , in CL'-t Qa Z-r , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I o ation.
I 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)
9
7
Sr
I WAIVER SECTION �C
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 requirement.
(Property Owner Information)
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Prrnt or Ty e Name
6arvCep �o
,hlaifing A ress --1 2 �S
1a — f ff-kc -
Cii lState/Zip
all
Telephone Number/email address
Date
*Valid for one calendar year after signature*
(Adjacent P operty Owner Information)
1
Signature
���P•'Decnl����yk
Pnnt or Type Nfp/me
RECEIVED
Mailing6 Ness (V eA.Jr�- 1.
� , JUN 17 2015
City/St telZipTbTG
Telephone Number/email address
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Date*
(Revised Aug. 2014)

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: m A 6 ! N C51, 1 e rvrn 4 n
Mailing address: o49 TDn N e-ee C o u
CAV-jpowl N -C_ -Z S1(o
Telephone Number: z S Z 2 41— 1 111
I certify that I have authorized M U p 7 rjS1 Nc�,(age nt/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 1`)0cK
at my property located at I 3 Z —T N C> I a r) S kor---S C-c-,zl —
This certification is valid through (date).
(Property Owner Information)
Signature
M ArL+ )N t5 L1 1,e,►�►9 n
Print or Type Name
Title, co. owner or trustee for property
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Date
-EIS 2 2q-I 1199
Telephone Number
Email Address
RECENED
JUN 17 2015