Godwin, Bonnie

DCAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
fJNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources -711 / CJ rr `,�
and the Coastal Resources Co mission in an are of environmental concern pursuant to 15A NCAC ti
Rules attached.
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River Basin
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❑ PWS: ❑FC:
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Closest Maj. Wtr. Body
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Type of Project/ Activity
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(Scale: �J )
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A building permit may"quired by: Z'T f-" / ✓ i- L( r� ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions A )t _) � t :,r t -+-11 1. j �i 1 C t• - �1 t�/ 1' ? v/
y
AgenrorApplicant Printed.Name
Signature Please read compliance statement on back of permit *"
Appf cation Fee(s) Check #
Permit Offices s.5ignature 1
Issuing Date Ex Dati
Local Planning Jurisdiction Rover File Name

f
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
nullandvoid.
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 ❑ 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 howto complywith 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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to I) b N to iE G o 4 w , W is
(Name of Property Owner)
property located at �� Z 'Emsn� f7 TUO "a 4 .,- 1� J
(Address, Lot, Block, Road, etc.)
on So ,-�D , in ,Er,v-ra -0 1q:5( E , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
`R w 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)
E
ok- .
REcEMD
MAY 2 7 20A
WAIVER SECTIONDCMMHDCITY
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.)
9 .L-3 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
o -0 t�l I to
SiSure -
P bt or Type Name
'Po 4<9 15
Mailing Address
11 Lm-a N, C, 7157b
/StatelZip
4`( 1320 n`i 4�
TQ/e hone Number a : 'CEIVED
0
Date MAR 2 5
(Adj ent Property Owner Information)
Sj ature
Print or Type Name
M in Address
0-
CV /Zip Sf
Ter
"s hone�� Nu13'V' o�
Date
(Revised 611812012)
DCM-MAD C(Ty

AjRj
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director . Secretary
Date — (O --A
Applicant Name cf)��,
Mailing Address
7h
I certify that I have authorized (agent) DM apS, Z c-- to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
B O-)r) L) d�T , at (location)
This certification is valid thru (date)
Signature
r
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.ncooastalmanagement.net
An Equal Opportunity l Affirmative Action Employer
RECEIVED
MAY 2.7 2
bC►-MflnCI`rV
HEMIVED
..MAR 2 5 20i4t
DCM MHD crry One
NorthCarolina
NaturaAff

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to r3o N ,) —joi GoDc,,,j I
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on �o ,Soc,�, p , in Elr'?S44 —L51 ulr- ; N.C.
(Waterbody) (Cityfrown and/or County).
The applicant has described to me, as shown below, the development proposed at the above
location.
✓ 1 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)
L) �t
U WT hyrs
`)-2nEF 0
Li 4}-
0
�.: ItECENED
MAY 2 7
DCM-MHD 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.
I do not wish to waive the 15' setback requirement.
(Pro erty Owner Information) (Adjacent P operty Owner Information)
Skv�'(
ol.•�- Goef1� ,,., Signatur Signature d � lu�T�,'�:vr,, yu�z5}'tr /�y�•�1�:.�.
t� ,1kl
Pri t or T e Name Print Type Name
`� o �� 5 701 -1'x $16
Ma'ling Address Mailin Addres
��L-M► A- 1 /- ?l LS'-l(� �,y�i -t5 --ram , 4)4. Zed Sf3 h�
City/ tate/Zip City/ tate/Zip
I q 320 —L(�(o �q10 - 3��1 (3101
Telephone Number Telephone Number
- — Zo — IJ 93/ /ARII'
Date Date
iECEWm
(Revised 611 a12012)
MAR 2 5 2014