Heaton, Chris

CAMA / ❑ DREDGE & FILL���S
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EN ERAL PERM IT�JF��
permit #
New ❑Modification ❑Complete Reissue ❑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 I SA NCAC
Applicant Name r�-� r J"t
Rules attached.
Project Location: County ,
Address ' ' 4t, ! 1 �� 1 i i 1 -i !
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Street Address/ State Road/ Lot #(s)
T'.- .
City. , � 7—State ZIP �f
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Phone # ,1 -Mail
Subdivision
Authorized Agent 7 :... , `) l(. 1 (�
City ZIP i
ElCW EW PTA ❑ ES ❑ PTS
Affected
,
Phone # (: '` `-) �� >� ` tl River Basin° �.
'
ElOEA SHHF ©IH ❑ UBA ❑ N/A
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Ad'. Wtr. Bod j � � t � } i � i i i %naf Jman unkn
ORW: yes /Uno PNA yes / �o / r
Closest Maj. Wtr. Body
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Type of Project/ Activity �L! .¢;at-;1t- t 'it`;1_
(Scale:
Pier (dock) length`""
Fixed Platform(s) "~
Floating Platform(s) _..-
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore'--
max distance offshore —
Basin, channel
cubic yards —
Boat ramp
Beach Bulldozing---
Shoreline Length (f
SAV: not sure yes no
Moratorium: n/a yes
f -
Photos: yes
Waiver Attached: yes �no)
A building permit may be required by:
( Note Local Planning jurisdiction
Notes/ Special Conditions
❑ See note on back regarding River Basin rules.
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Agent or�Applicanf'Pnnted Names PermitOfficer s Printed Name
Signature *,!Please read compliance statement on back of permit*,y*_ -, Signature
Application Fee(s) Check# Issuing Date
txpiration uate k
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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, certify that 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 howto 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 Citv 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.nett
Revised 08/27/14

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AG ENT fkUTHORIZATION FORM FOR PEHRMIT APPLICATION:
Name, of Proport}- O rvner Applying for 'ermit: G
Mailing address: e-, �< ti/ ti c> y( LLS
Telephone Nuriber: C.)
certify that I h ive, aiithorizE:degenc rtractor},
to act on my bE ha If, ter the f,urpose of 4.pplying and ob-laining all CAMA permi
necessary forthe `Ie prc posod developmel it of_ Ie c atZ Z r
at my property I oc,ite I at _ �. / GG,(��(/O A � ..
This cerfificatioi i is valid through —(date).
(Property Own :r nformaticn)
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Pfint or •
Title, co, owner or i ru: tee ibr prop
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Telephon,. Nurr-ber
Email /.ddress
RECEIVED.
SEP 21 1015
RECEIVED
SEP 18 2015
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EDIAZEV IP RIIN. PEkrY'?,YVNERSTAA rEIENT
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T tua aCpt an: to I! :csc bcJ to ire. as staaNn to .n'. t a -It Frcpd'-e a t m
C b, ed ors 11 this; ropcsai.
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Dda;,:: S tri�fsrn :m cis!a: tc1 0 1� t,�m ml area ct fipari�l 1 �,:cEss un'aas w3.•.'Nd r r_tn. {!! j;,
wish t" rra:.c 'h.c ae oad , y rJ must Init at :h'.r a; pfcrPr.1a b -r,k
4o Ki i to ova ve V,a :5's• rac:, ley:Jfcm, rr.
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SEP 18 2015
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PDJA ;EVT RlPARtN PR2PERTY O'111 NER STATEMENT
1 hereby cerl f}, i hal I aw I
propertylacsfcc at 2.5-j% r rt aof
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"r` SA-idroI l.c�t, Bit�sk. oad, etc. }
all { _.� ... �` .. I in ... e tr' � �,,
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(CitylTown a ndfor Coo ty)
"cis •JP�S aibcrd to rne, as Shown below, Oe clLiveloprnent propose at Ule above
10MUDn.
I lay. no Objection tothh. proposal.
I I mli Z obi ad ons to this l` roposal.
E ELCFIPT� M ANDlOR DRAWING OF PROPOSED REVE!_O IIAI� IE i —
�t+rrldlrriritl it p ropes Ing c fov lopmenf rrl ust fill in deser►pition below ar atfacir a ►ito dra1virrcrl
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1NkW R SECTION
1 un&;rstand i�mi a tier, iork, mooring pilings, breakwater, boathouse lift, or ciroi rtiusl be set
b-Ick?a rniniin rri dictanc: oil 15! from mV area of ripariaa =Css Unfess Waived -v me. (it you
vrish to waive 'he se bad, Y.Ar crust initial the apprcpri V.c- bank bedaw.)
1 do vi! h to ,naive the '15'siAback requirern nt.
I da no[ Wisi to waive the 1 5! setback requimrnent
(PropertyCMnevIn'ormation)
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