Garner, Jeffrey

L CAMA / 17 DREDGE & FILL
.I.• A B
C D
ENERAL PERMIT
Previous permit#
,
ew OModificatlon El Complete Reissue 0Partial
Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
''. 4
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �'� t. �✓ ��
i I
Applicant Name \,� "`- ' it 1 - + ! �' ,{ Y'
El Rules attached.
Project Location: County -
Address `t �. .I- t l ' "' " f ! I
Street Address/ State Road/Lot #(s)
City }� +ti .;, r
State- l ZIP-._/
t
r.r
Phone #±`:''&,Mail �—
, Subdivision
Authorized Agent', ? � i. ; � � ,. � ' (� "; � . i , ; t i ./ )t
1.
�' City y # r` � f � < ' � � r' ZIP
❑ CAM EW eTA ❑ Es ❑ PTs
G*,Phone # ('. t a �) " { `'- r i'J) River Basin ; ` ��r•
t' J
Affected
() ❑ OEA `❑ HHF ❑ IH ❑ UBA ❑ N/Ai
AEC s
1 i;4 i f .� ( �� •° ( 1( Y riat
Adj. Wtr. Body t i t T_
man /unkn`
❑ PWs
rr r
Closest Maj. Wtr. Body
ORW: yes / I no : PNA yes / no
Type of Project/ Activity t" ► a I
( '
' (Scale: )
Pier (dock) length �✓
Fixed Platforms)
r i
.1
Floating Platform(sJ
I I
Finger piers)
Groin length
number •-- v
Bulkhead/ Riprap length ` t,,
, i; ,b ' i/
avg distance offshore'"` ty '
'
max distance offshore--
I
Basin, channel
r
cubic yards
I
Boat ramp
l" r ��-� h
'.
l•
Boathouse/$oatlift
Beach Bulldozing"
Other-; i=' t- -;
'
REr E
Shoreline Length
I I
SAV: not sure yes no Lj
Moratorium: n/a yes ('no
_
Photos: yes no
Waiver Attached: yes( ;
r l
ri`
I
A building permit may be required by:
1 i- ` r t !
El See note on back
regarding River Basin rules.
( Note Local Planning jurisdiction
1
� I
l t• Il
r 4� )
Notes/ Special Conditions I
i! ` . j'�' i
, j t
) f i -"
t ! ! r
l-
` r
r
Ag nt.brApplicant Printed Name r
Permit Officers Printed Name
Signature * Please read c-o8mpliance statement on back pf permit's*
Signature
Application Fee(s) :
Check# _
Issuing Date'?
Expiration Date

I
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)priortoundertakinganyactivitiesauthorizedbythispermit,theapplicantwill
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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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:
Mailing address:
0
NZ, a i55
Telephone Number: a -ELF I - a l 85
I certify that 1 have authorized ma (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of i,4,,g-1aU ty)A 50' SG 1-f / r
at my property located at 5,n I -M/ r-oQ,
This certification is valid through a� (date).
(Property Owner Information)
C
Title, co. owner or trustee for property
Date
o25a dLf I - 02/ gcs—
Telephone Number
Email Address
MAY 2 2 1015
-:tYJ-t��IJ6 CITY
RECEIVED
MAY 2 0 105

ADJACENT RIPARIAN PROPERTY
OWNER STATEMENT
I hereby certify that I own property adjacent to-2-�-'rY`et1
(Name of Property Owner)
property located at 01 ie r& _
�,/I- __ (Address, W
lock, Road, tc.) N.C.
on r � (�VISYYY1 , in
(Waterbody) (City/Town and/or ounty)
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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing'development must fi(Iin description ,below or attach a site drawing)
See—
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 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
ailing.Addres " �� `� n q�•5 "7
crtvr,55
io��!
Telephone NumberLwail address
Date
*Valid for one calendar year after signature*
RECEIVED
MAY 2 2 20115
RECEIVED
MAY 2 0 2015
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to V e LCCg: -1 6cwme r 18
(NameTof Properly Owner)
property located at 5-4aa� A.
0 (Address, L t, i31oc , Roa a .)
on aaw, %w C6,nne- , 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.
I have no objection to this proposal.
I have objections to this proposal.
.DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing.development must iill:in description below or attach a site drawing)
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 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
(Pro OwnAnormation) (Adjacen 01 r Information)
RECEIVED
Si •e Si rep`. h MAY 2 21015
6>0Uy- �pM trl}
Print or Type Name Print orType ame
t I I j?h JAd 42S Lan at Lna G
Mailing Addtes a ' S Mailing Address
inn inn 11�..��11 /
Cifv/State/7-in Clty/Sfate/Zip ,
Tele,n! umber/Mall address Telephone Nu er/e address RECEIVED
/.
Date Date` MAY 2 0 206
7 7 (Revised Aug. 2014) ny I
*Valid for one calendar year after signature*