Freeman, Robert

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT 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 -71
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC I
0 ules attached.
pplicant Name Project Location: Countyi^i <
City State r',Ir ZIP '
Phone # (' ,, . ,..} Fax # O
�Authorized Agent i 5 11 f r
Affected ❑ CW 0 EW -.Q PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ WA
❑ PWS: ❑FC:
Street Address/ State Road/ Lot #(s)
JT
Subdivision
City A f 3 ZIP
Phone # ( ) River Basin
Adj. Wtr. Body ! (nati /man /unkn)
Agent or Applicant Printed Name Perniit Officer s Signature f
Signature - _* Please read compliance statement on back of permit Issuing to rExpAtion Dates
Application`Fee(s) „. Check# Local Planningj'urisdiction 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:
El Tar - Pamlico River Basin Buffer Rules El Other:
Neuse River Basin Buffer RulesIf 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/ 1-888-411COAST
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 Mail
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

r
HDENR
North. Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date -!- Z / — %y
Applicant Name to . �A�
Mailing Address 2 2 1 .SA i th S,f
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) `te t to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
ZIT -WART
2'2 ( Srtn,Ji-In Sf ► J��'Ia.rf �G !Q _� .
This certification is valid thru (date) $— I-- 2014
Signature
10.
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX:[phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity %Affirmative Action Employer
at (location)
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N 2 5 2014
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NorthCarolina
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
- - - - -- I hereby certify that I own property adjacent to- /R m a M (AN _ 's - - _ ..
ypC4 (Name of Property Owner)
property located at 2Z1 Senr n+ ST. ATLRts`t-tc SCJgC-K_ t3. C • �.8 iZ
(Address, Lot, Block, Road, etc.)
---�j on J&o ae SoyNcO , in Af-I'mk' 6-yC'k N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
log do
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)
X gx�
o
��stins
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i
� ► 3� ,w, RECETVBD
JUN 2 5 2014
WAIVER SECTION`
DCM MUD CITY
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.)
I do wish to waive the 15' setback requirement. 14C6 Q T.+% fiats
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adj ent Property Owner Information)
Si ature Si�n��e
/y6, 4 f v�
F, aERT D. �Ri=�/y�R N lt�o
Print or Type Name Pn t or Type Name
Mailing Address il' Addr s
c . �,28�Iz /LL M21 � S
City/State/Zip t St tee ip
72 6 `i 81 �F 30 0 -
Telephone Number eleph a Num
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Date Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that l own property adjacent to--RoaE A - D 6REE1"A - - I
(Name of Property Owner)
oK property located at 221 S„� r ru S7
(Address, LotBlock, Ro d, etc.)
on ' ot C4,1C Sow4 , in ;610hfc e" . Ca�+fc.�r�- , N.C. 21i�Z"f2
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locVLJ
.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
f'#t14Y
8YW --I evxf f
t P�Q �3 158c"14
r1,ce,Nah S speo p,
WAIVER SECTION
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;Mml you
wish to w ive the setback, you must initial the appropriate blank below.) r''s"'
1 do wish to waive the 15' setback requirement. JUN 2014
I do not wish to waive the 15' setback requirement. DCMMMCMY
(}Property Owner Information) (Adjacent Property Owner Information)
�0� S' nature
o,�EFZT D- EKEPS VIAL]
fi Print or Type Name
`� `—'l Z a f G tf%,-rK T-
0�,� Mailing Address t C
A -r L A 1J Tl C Rep c tf _ /Y a's3 51 Z
City/State/Zip
Z5z ?Z6 98l�f
Telephone Number
21-Z40 �.
Date
Signatu e v '
Print or Type N e = 4
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t-i �ls
Mailing Address CKc4-
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ciryisrat�i7Lo
Telephone Number
Date
(Revised 611812012)

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Printed June 24, 2014
See Below for Disclaimer
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