69840C - Hondros, Randy

,GiAMA / .DREDGE & FILL A :C
DENERAL
PERMIT
{ ew ' ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued'
a As authorized by the State of North Carolina, Department of Environment and Natural Resources
Resources
and the Coastal Commission in an area of environmental concern pursuant to 15A NCAC
'KiRulles attach
Applicant Name ( \ %' 1.. t„ �, Project Location: County { ' i I �✓
Address j w!, `' ' ' j 'UStreet Address/ State Road/ Lot #(s)
State !�.!�. ZIR' �" :�
�
Phone # ( / "" Subdivision
E_Mail -'
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Authorized Agent e. 1�1%�'t�) ;? 1,"; �,,��t.°..+, ity �'..' �'+ ! ZIP
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Affected �kcw w �*TA ❑ ES ❑ PTS Phone # River Basin
' ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A f / . r s
:i AEC(s): Adj. Wtr. Body ,._� . '' ` ' ' (nat
/man /unkn)
El PWS:
ORW: yes / no PNA yes / � Closest Maj. Win Body
j ( r r ;,
e of Project/ Activity�+
F
Pier (dock) length
Fixed Platform(s)
Finger pier(s)
Groin length
number—
Bulkhead/ Riprap length
avg distance offshore
max distance �ffshore
Basin, channel
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cubic yards --.-
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Boatlift
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Beach Bulldozing
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Waiver Attached:
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building permit may be required by: See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction) ! I+.
Notes/ S
peciao ditions
Agent orApplicant Printed Name Permit Officer's Prirjt a e e'
y m, i
"J
Signature *please read compliance statement on back of permit • * Signature
Appiitaiaor+)=ee(s) � Check# Issuing Date E�pti'atton pate r
'rvr ^'ti .� Vs q i n ���r fr . •,�� n 1. ;r i ; i (��i, , � n ` 4. >,'tSsi �ti P,., .' a u •,,,• •�2" a rw:%�1 � � . a Y��� '-'7 � ruy�'�,e. � J�.� � iy7 '1r4 ..� ����+�'���. r•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) 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 how to complywith 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

CAMA El, DREDGE & FILL
'D
'ENERAL PERMIT Previous permit # A B
.ew QModifi,cation [Complete Reissue [Partial Reissue
Date previous permit issued
uthor e'd by the State of North Car
olina, Department pf. Environment and: Natural Resources
e coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC C J
WRules attache
ica Project Location: County—',
re
:Street Address/ State Road/ Lot #( M
I t A, I State I ZIP
Ul - , I ` -,I
k V1
E-Mail
'�Subdivis,ion
Prized'Agent 1_0A V 4)
�kj ity vur)
JZIR �T
.ted *,'TA 0 ES 0 PTS
hone #
River Basin,"
El OEA 0 HHF ON 0 UBA El N/A
0):
Adj. Wtr. Body"(1
-C
VYk ( I'(trron /unkr
0 PWS:4
pat/
yes PNA - yes/
Closest Maj. Wtr. Body :nlll�z�
e 1� of Project/ Activity
ti
(Scale: /I =60
(dock) length
dPlatform(s)
FFFFRH-1
11
11 11
1
1
1
&114
11
IF"
1
1 ti
4
v
10ating Platform(s)
lng!T:pier(s)=�
roin, length
number—
ulkhead/ Riprap, length
avg distance offshore
max distance offshore
asln, channel
cubic yards'
Dat rarni p
6athouse/ Boatlift
naach Bulldozing.�
oreline Length
N,::. not sure
yes
y
no
atPrium: n/a
yes
es
ot6s:,
yes no
aiver Attached:
/6)1 nn
:)uilding permit may be required by:
Jote Local
c I Planning jurisdiction)
❑ See note on back regarding River Basin rules.
)e ci al Co di ions J,1r0
Y J 00 (�-k/
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is ri
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e—)
,
Y16,-A,O_P Z1111"31111/7
plicant Printed Name
PerrnitOfficer'i PHkeWINarn
lease read compliance statement onback of permit
Signature
Check #
Issuing Pate
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: AV'J'b
Mailing Address:
A i l_.._ /V e-'-j
Phone Number: -3 -3 b - g 72, --( ( 2 7
Email Address: �a !�4 rv%
certify that I have authorized I �- �n J i Qz> Sep J ► c'e_
Agent / Contractor �—
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: s i-C "c+ 0'/ L_
P°Cr
at my property located at jZ�
in 067"_�e_✓e 1- County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Prope e' Information:
Signature
/'J A,,J/��to S
Print or Type Name
Title MAR 15 2017
.3 q / /7
Date DCM- MHD CITY
This certification is valid through le / I `"7
!,,,"AR 0 9 2017

I hereby certify that I own property adjacent to
I
Name of Property Owner)
property located at �� .y S ��^^ -�-, JO-
�---� (Address, Lot, Block, Road, etc)
on CV e- Ste' ti �- , ,in x-r•,) , I L 9 i c-4 , V.C.
0 (Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat
1 have t7o 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)
Tjo,�
i
2 p i e-C
\I 31
i
S�U-3i0'�-.
l � I
LD f
o12G�
r 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.
CEIVED
I do not wish to waive the 15' setback requirement. MAR 15 2017
Owner Information)
Zature
/IDAJJleoS
Print or Type Name
/'�7.15/a,I d e-,
Mailin Address
WV
City/State/Zip
3-vejl;r-6�,77@aM4l, ©n�
Telephone Nu ber%mail address U
Vp)//7
Date
"Valid for one calendar year after signature*
(Adjacent Property Own CITY
4-1_Ie�
Signature *
Print or Type Name
�y3 / A)A S /f (-� /0
Mailing PAddress
G�"se) �lC---)n �—
Ci4/Sta1e0p
2,SD-' 39g-iiPi7
J T,elephone Number/email address
Date/
RECEIVED
(Revised Aug. 2014)
fvi a.R 0 9 2017
®CM,_ MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to F,-'J'A 2 O S 's
�a �� (Name �Prr`�oper caner)
property located at � % V
C--
� (Address, Lot, Bloc Road, etc.)
on LJo� L� �c�V,nl (� ,.in �1 TLpn1 T/ C %3�AC/-� ,.N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Won.
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)
` I rnI Ie"X I (a' TD)0C-
s' w`DF RECEIVED
Irv`
MAR 15 2017
q` F�atJDR�S
DCM- MHD CITY
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.)
E9� 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr caner Information) (Adjacent Property Owner, Information)
Signature ignature *
Print or Type Name Print or Type Name
Mailing Address Mailing Address,
�C25/ZFt�,...�;� -�.95512
City/State/Zip City/Stateao
336-9`7ot-Co(977 r U a aG oz5�- All-7- Oa? 7
Telephon N mber/email address 4#10,%Telephone Number/email address
C 3 Z Z/ -
Date ��h Date* r
"Valid for one calendar year after signature"
RE k .2o14)
MAR 0 9 2017