Kelley, Keith

CAMA /,N DREDGE & FILL
I GENERAL PERMITW Previous permit #
New ElModification ElComplete Reissue 13 Partial Reissue Date previous permit issued
A, 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 ") 7'
Cri Rules attached.
pplicant Name
AtY
ciclress V -z
f,
u-, State ilp
'hone # (,—)L Fax #
kuthorized A2ent
Affected
AEC(s):
ORW:
OCW -EIEW _.,0PTA -LES 'It PTS
0 OEA El HHF 0 1H 0 UBA 0 K/A
El PWS: OFQ
yes no, PNA yes [-ti&, Crit.Hab. yes /,,no
Project Location: County.
Street Address/ State Road/ Lot #(s)
Subdivision X
City ZIP
Phone# River Basin %I t-
Adj. Wtr. Body (nat finan /unkn
Closest Maj. Wtr. Body

r
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 consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
F1 Tar- Pamlico River Basin Buffer Rules ❑ Other:
0 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 how to comply with 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/ 1-888ARCOAST
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
I hereby certify that I own property adjacent to k�I -%;' e.-Ov is
(Name of P perty Owner)
property located at _� 12��� IC co:,.�� j
(Address, Lot Block, Road, etc.)
on a r�,A L , in Pl<� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
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.)
RECEIVED
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
1•
Si nature
Pt or Ty e Name
Ma g Address
City/State/Zip
ZSZ 2y7 —i3o(•
Telephone Number/email address
'Date
*Valid for one calendar year after signature*
Propertv Owner Info
APR 14 r1%
P#�-*:Mae 4 Nffv
Signature VJ —
•s ew40 ru
Prin or Type Name
I9a1/ lri,'llow S,n
Mailin�` Addr s rh / /Gl�l b ,� -, 27S2,2,
City/State/Zip
os�z-
Telephone Number/email address
h/-S =1 -�)—
Date *
(Revised Aug. 2014)
(:�/d'rrLw 1S a% Z46,OZ

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i In V t-- I lniis
(Name of Property Owner)
property located at I 4E 14 aLl2q
(Address, Lot, Block, Road, etc.)
on Z A v,, A (._ , in GCS , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_�_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must itll in description below or attach a site drawing)
RECEIVED
WAIVER SECTION b7t1' 14 2015
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or gr
must be set back a minimum distance of 15' from my area of riparian access unless waived :Mgef ffy
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.
(Property Owner Information)
2�4'-
Inature
Print or Type Name
1 1 - It L� ►�'�'
Mailing Address
'P 1, S 2%11;1 2,
City�ylStatelZip
-z45r 72—y7 'J Jo 6
Telephone i uumberl email address
Date
*Valid for one calendar year after signature*
Prooerty Owner Inform
4
Sign J < -rti lte, C
Print Typslyame
"ItA4 ,Pts
Mailinty Address
rl�a_vv. , !U C a-`1 7
City/State/Zip
,qIq-115>; 71 Wa6bwri+e,5-6&"'1
Telephone Numberl email address
i� b�-i i Xerl5
Date*
(Revised Aug. 2014)