Fisher, George

�CAMA ,DREDGE & FILL
'
QGENERAL PERMIT Previous permit #
tNew OModification ElComplete Reissue ElPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission an area of environmental concern pursuant to 15A NCAC
ZRules attached.
pplicant Name
Project Location: County En_,"J_r
Address
t
�-Aa )1, _-, — Street Address State Road/ Lot #(s)
J
I I V
;City State ZIP,
�ic .4Am-, I t 1_11 I ( 4
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I Phone # Qf- Fax # Subdivision n(
Authorized Age' Zip
Agent !V-_)
F) i, City 11 (
Affected OCw �fW _qPTA bjS El PTS
AEC(s): 0 OEA 0 HHF 0 lH 0 UBA 0 N/A
0 PWS: OFQ
ORW: yes / -ii6 I 1PNA yes n,;(' i Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin len��th -----
�umber
avg distance offshore
x distance offshore
ma...............
Basin, channel
cubic yards
Boat ramp...............
Boathouse/ Boatlift
Beach Bulldozing...............
0-
I
Phone # I I0 I I ""-f / River Basin Adj. Wtr. Body J —f)
Closest Maj. Wtr. Body
Y
(Scale:
El See note on back regarding River Basin rules..
-IV C
Age or Applicant Printed Name Permitol"cer'l Signature
Signature Please read compliance statement on backofperri� Issuing Date r Expiration Date
................. ,
Application Fee(s) Check # Local PlanningJurisdiction 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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules F-1 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/ I-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

GP Habitat Sheet
Name: George Fisher Permit M 63832
Date: 6/2/14 Address: 111 Bowen Street
Habitat
SF of Disturbance
SF of Disturbance
LF of Disturbance
LF of Disturbance
shoreline
170
170
N/A
N/A
JUN 112014
ACM MHD CITY

w
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date <7 - 2 a -- l i
Name of Property Owner Applying for Permit: JUN 0 2 2014
(S o—e- !� rj't� .0 t, < �, c r i l l DCM--MHD Crrr
Mailing Address:
I certify that I have authorized (agent) my O 9,.,C- 22=c!54" T.cto 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)
This certification certification is valid thru (date)
Property Owner Signature Date
JUN 112014
DC.4.:Y-H-D C.U. V

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to e- r 5 e -F t --, In ` f— is
(Name of Property Owner)
property located at '-J Qa V-1
(Address, Lott Block, Road, etc.)
on Cr3 wi9l_ . in N.C.
(Waterbody) (City frown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND1011 DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
}o, JUN 0 2 2014
a
' ACM Mom? CITY
lzt-p i/d<C- vrt Eu,�:J
�►-� oy.'-T ate' , l >;,g t-J 11
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.) RECEIVED
I do wish to waive the 15' setback requirement.
JUN 112014
do not wish to waive the 15' setback requirement.
(Property Owner Information)' (Adjacent Property Own JKWbn)
Signature Sign . re
Print or Type NaN
Name Print or Typ ame
Z� 2� IS"-2 V7 A l � cl �> ML) Ent s 7�
Mailing Address Mailing Addre
City/State/Zip C' /State/Zi;S/ Z
Telephone Number Telephone Number
2-41 l -2-/ 2 G 1 �4 -L, 4 '7 —of N / �
Date . Date
(� (Revised 6118/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to is
+_ (Name of Property Owner)
property located at (� I �o'"' �`'� � •�
(Address, Lob4Lj
Block, Road, etc.)
on A�� , in /4 i t J��"i% c . N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc ip
rj 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)
Lv.►S-i )u-7
RECEIVED
�1'S'� 1►.r5
�oc10
Tr JUN 02 2014_
_%m-Ni W CITY
t� Ie---T
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.) ;t RECEIVED
I do wish to waive the 15' setback requirement. JUN 1 1201A
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner n orma 'on)
Suture Si at e
rf 4
Print or Type Name Print & kpe Name
M ing Address
4)les�, t�(• C . 27toG7
Cit /State/Zip
)� �y� BSI
Telephone Number
Date
Mailing Address
Telephone Nuinr t _
Date
(Revised 611812012)