Hale, Sandra

CAMA / El DREDGE & FILL
/�
IV A B C.l D
GENERAL PERMIT
Previous permit#
New ❑Modification ❑Complete Reissue El Partial 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 I5A NCAC % • f J
0 Rules attach.
Applicant Name
Project Location: County_
Address n J \/ �f' t _ ?. rst'
Street Address/ State Road/ Lot #(s)
city f`t�F'/'fry€' State f c %?
tZIP
Phone# r:llf -ilsi�,�f,r,dr
(�)- E Mail ''•
�t`�t10���}
Subdivision _
]
Authorized Agent t f4r'�.? ;' j r l�;Y f ,'?. I
City ' i f'' r i!� ,,•,� f'f; ZIP'
El"� EW 'I PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
Affected
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s):
Adj. Wtr. Body i "' f "� i'`_/ x ! (nat man--/unkn)
Closest Maj. Wtr. Body
ORW yes / na PNA yes /� o)
Type of Project/ Activity
Fixe
Float
Fing
Groff
Bulk
Basin
Boat
Boat
Beac
Oth
Shor
SAV
Mo
16
Phot
W'
0
r-
(Scale:
length
ONE
number
�
�
avg distance offshore
u
max distance offshore
OEM
,channel
cubic yards
ram ram
�
i
Ca■
a
��
MEMINEONEE
Nis
NEEN
ON
1=111
flown
A building permit may, be required by:
( Note Local Planning jurisdiction)
i j�
Notes/ Special Conditions ,AJ � I
❑ See note on back regarding River Basin rules.
ent or licant Printed Name , f( Permit Officer'es Printed Nam
APP
Si nature t* Please read compliance statement on back of permit * Signature i
Application Fee(s) Check# Issuing Date . Expiration Date

-i t
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 I) 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 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 complywith 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/ 1-888ARCOAST
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.nccoastalmanagement.net/
Revised 08/27/14

r
Narno of Property Q.-merApplying (cr Permit: - `�--—t.lt..--
ldaling addres+:
_ 1.3)F n) F1 l�l . C �n sg l
Telephcae t4umbert
i certify that i have auffixized k/im Ck GA- ogenticontractor),
to act cn my bohal., for the purpose of applying and obt�ning all CAMA permits
necrczsary for the proposed development of o� (' r 1 i C•LC��
at my p7opvty Iot;,ted I`
Ttris ocrt: _':gin is vu J ,-iJo�jgh a S (dote).
ShoRe-S
— 8-am
i at, , cc. avrwr of vustu-0 for ,prop61ty
1D l
D`r` RECEIVED
tO -1 — r] 1 JUN 17 2015
Telephone Number -{ lr°1'tV�' filly
_S AtJdpol;.�e�.1,-
Email Address
RECEIVED
JUN 15 206
DCM-MHID CITY

I hamb � cortry 1hst i c%*n propa:ty 2<atarrt to __�S_?��J
prwo;ty t;, A!c4 &I
F�
all
(Addre=, Block,1% a. ®tc.)``
on r, L11f1`) Sk1A?P84.C.
(Watcrbody) (CItyJ o► Ts andror county)
Tra aplxxant him dc:.;rRrd to m, as storm Wow, th- r;;,webpm&rnt pmp:- ad at the .=togas
1 h:raa r►.: o!,':eilarr to th::. propel.
I hwa u otjvc&�-is to Mis pro�cs l
DESCRIPTION ANDiOR DRr' VY111(; OY r. "0-9 D DEVELCIRWENT
(Jndi7dualprc as'ng dcveopment must Vf/in do rtpw,;,wba;0W orattach a atr:c dr_NJn;;i
� 10 av4 W
T�sd� f�'�aao' �oQ:•q do-�_
Li►AIVF-R SECTION
I urdcmt;nd trot a Pbr, dock, moonn3 piling;. tact ramp, tonttQW,0. f l,, or groin
must bo sat back ;a rrtnirnum d.st nce cf 15 from mi 6rea of riparian access uri6ss wili;rE.1 by
mo. ('4 y(u w: h jo w;:.a try cE=K, ycu muit lnWal t v aPW0 ;ria',j=! t:�nk belatv)
�I I do vii5h to w lvo Qua 151 =_t a ;k regta.eTEnt.
I des not „M to waive tno 1 S zebacx requremeit
{Pr p ,r Owr:cr lr,.�om+a''aI (Ara(acant Property Cwncr tntoamatson)
r, i�1 tfS P a O. i K A 3% Q
.�. agstia
CAN
I r 11 r(1
"vr_.d for on3 ralcrdw yow a liar s: q t; .m*
x>ty `!
Ili&.isad Avg. 2014)
RECEIVED
JUN X 71015
•�e�l� r,� jSl
r
RECEIVED
JUN 15 1015
DCM-MHO CITY

DJACEt{T RIPARIAN pROPERTY Ow-lER_STATEM 1
1 h.ro:ry co:u y thsct I c%4n propo fty 2djaWre to b �T�
�� � - 1 t►� propo.ty tacolc f at a lAoclfll�E�
ERG
�t1? C���l add:;. t. lack. l f tG.y
on. n is ►
(watcrtsody) County)
tra appt�a^t ha: =;cribvd to ma. as srown Wow, tht 'tom-v-:bP teAt PmPz.;cj al V-0 a Ova
kcal
hwa na ob,"—tion to Utl;i proposal.
h« a o�Jctions to C,is prtFxasai
DESCRIPTION /Al^ OMR DRAWING OF PROPOS D DEVELOPfst�NT
(kic ildvaJ prvpastng d4welo pent nrual t.111 in d=cdptiod WOW or attach a sit4 drral'12R)
bo-w GZ�lj o(t s 09geLk (p x o0, ;)4)ce d G
WAIVER SECTION
I sir - pf., t -.; ;iv. d0a. mock ng plane. t=,*, rarnp, Coa;rouw< f r,, or grcdn
nr:' i Ga til1: ,..,a„ y mini nurTs d .f it 5 Cr 1$' fra-n my area of riparian soots unless weived b/
rr._=. (if y.0 4 - t ce=ck, you trait Ini'.fal tt": appfo, fla'.e. tank belzvi)
1vo thts , V s=t .ash regLirew-nI.
I do not %iiah to wave L"4 15" st:!=X requrem_;rt
(Prcpsrti Owncr Inr Iron) - (J,dj� nt Presort"/ Qvmcr c}rmation)
1prr,'k or Try1►'I'M PAVA T1)wAtime r
S—
I'Rs. sOd A-v;. 2014) RECEIVED
'v; d bw mz calersdw yow eiar
JUN 17 1015
RECEIVED
JUN 15 206
DCM-MHO CITY

an
✓ r,, Hal f e�
5 P"
40
r
d
I;
- # ,t
RECEIVED
JUN 15 10b
DCM-MHD ON
9CENED
JUG. 17 1015
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