Gross, Earl & Elaine

El CAMA 0 DREDGE & FILL
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GENERAL PERMIT Previous permit #
QQNew ElModification 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 in an area of environmental concern pursuant to 15A NCAC-'
[Rules attached.
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Name Applicant kCounty``\ (. 1— Project Location: k
Address— -'A t k 1A Street Address/ State Road/ Lot f(s),
State, ZIP-
Ci
Phone # Subdivision-_ j I
E - M ai I
Authorized Agent cityZIP —
0 Cw DEW [P PTA DES 0 PTS one Ph #
Affected N i '. ?River Basin � I �)''
0 OEA 0 HHF 01H D UBA 0 N/A �' I, ( � h, � � N. .11 ((natman /6n i .
AEC(s): Adj. Wtr. Body kn)
0 7S:
( Closest Maj. Wtr. Body
Qn ORW: yes o PNA yes
Type of Project/ Activity
D;
er
Fixe
Float
Fing
Groff
Bulkh
Basin
Boat
Boat
Beac
Othq I
Shor
SAV
Mor
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(Scale:
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n umber.,
ead/ Riprap length
avg distance offshore.
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ramp
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ouse/ Boatlift
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line Length
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torium: rVa yes no,
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A buildingpermit may be required by:
E]See note o[)@MwfO"Be1TY
Note Local Planning Juri [sclicti n
A
Notes/ Special Conditions
S
A
Agent orApplicant Printed Name
Signature !*flease read compliance statement on back of permit
_­wAt
Application Fee(s) Check#
PermitOfficer's Printed Nam;
Issuinj Date Expiration Dat(

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 comply with 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/ 1-888-411COAST
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

>I-

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date I Zl ,Zj is
Name of Property Owner Applying for Permit:
Z Qy L GV,oss �- EI-,i �,, C,
Mailing Address:
5 2 o S' Lu-f- o c r
,fit, oye-1.i.e CA C-. 2 $ S s
I certify that I have authorized (agent) "DWI't ci v\- _ __ to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) K0.yg.k Lct vkv%
at (my property located at) 5 20 k t.ue, Ao Ca morcke-d CG b4 , Nc-
RECEIVED
This certification is valid thru (date) DEC 21 2015
Property Owner Signature
�-, DCM- MHD CITY
Date
DEC 14 2015
DCM- MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to F mv-&Gross l a i tea. GvG ss 's
(Name of Property Owner)
property located at 5 Z o T uj-f-6to c,r
(Address, Lot, Block, Road, etc.)
on S h oov,,—y` .s in ttlnor-e.�a_ cL l , N.C.
(Waterbody) (CitylTown and/or County)
YTh' nt has described to me, as shown below, the development proposed at the above
to
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)
RECEIVED
DEC 21 2015
WAIVER SECTION DC V _ y y D CITY
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathou e, i , or roan
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. .n,
RECEI�E�
I do not wish to waive the 15' setback requirement.
nirt 42015
(Property Owner Information) dTcent Prope Owner Information)
MILD CITY
�L
Signature Wgndt re* /
&x L. rs Gor ____�_l ai�n�CWos S' �Tftm 1,5 t� a U-t—lN
Print or Type Name P, rint or Type Name
Mailing Address Mailing AddfeessGt-t C g5 7
,A, ov—d. 'i-u . N c, 2 2 SS7 �'�( t-�h�
City/State/Zip City/State/Zip
dsa-"g,;L L(e4ccj-L7062
Telephone Number/email address TelephoneNumb r/email address
6 aLl f a.1 20t5 / lv 0
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

RECEIVED
0
DEC 21 2015

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Go-rt. G r o sS Z C 1 a i n e Coro Sr 's
(Name of Property Owner)
property located at 5 a o 7 t,V �elrolo CX'
(Address, Lot, Block, Road, etc.)
on S oo v,t-v- s Cy eye tc , in VYA ov�e-Ime Q Cc , N.C.
(Waterbody) (City/Town atfdlor County)
The applicant has described to me, as shown below, the development proposed at the above
loc��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)
RECEIVED
DEC 14 2015
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, bo ff,, I �dr )TY
must be set back a minimum distance of 15' from my area of riparian access unless
waive
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.
DEC 21 2015
1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner In io n ' D C STY
Signature
CM.-L G ress Glaiy,c Cross
Print or Type Name
5 2 0 8 LL"A'V3 CT
Mailing Address
�M or --in r, d Ca �S`j
City/State/Zip
)"5a..-'aa Lf533
Telephone Number/email address
/2/ /-2-//S
Date
�r� d4- 1-41,11, h
Signature* /J
t
Print or Type Name `�11
��U w Z�
Mailin Add,e \ V C -Z y
City/State/Zip
Telephone Number/email address
I Z/ I Z� I �'
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

In
4
RECEIVED
DEC 14 2015
DCM- &lHD C
20
DCM- MHD pme CITYg jecttT_�_
9'-71f
0
S
m is 252-764-1
to
252-648-SM