Langemann, Jamie

-
5CAMA 0 DREDGE & FILL 0, C. ,
GENERAL PERMIT Previous permit #
E)New 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
M Rules attached.
rpplicant Name Project Location: County
Street Address/ State Road/ Lot #(s)
�Mdress f
'City, -r I I State ZIP
Phone #
1-7 i/ =tiFax
Subdivision
zed Agent uthori' ZIP
city 0 1 T
El CW r EW -'❑
PTA �JES EIPTS Phone # River Basin V
Affected 0 OEA 0 HHF D lH 0 UBA 0 N/A
AEC(s): Adj. Wtr. Body iL- 111i (nat /vj�a6unkn
0 PWS: 0 FQ
Closest Maj. Wtr. Body —
ORW: yes (" nox PINA yes Crit.Hab. yes , 1' no,/
Type of Project/ Activity 0
J I V
(Scale:
Piece /
ORNMEMERNMEMEMEMMIMEMEEMMOMENIMEM
UMME
r pier(s)
ww�mmmwma
MENWEEKS
n
OMNI
cubic yards
MEMEMEMMEMMEME
M
Imm
11VINEMOMMEME
ONE
ramp
iouse/Boat�,ft!
Bulldozing
NON
MEMEMEMME
/7,
MIMMIENNEEMONMEMENE
NON
NEMOMME
r/
limmEMMEMMEN
OMEN
ME
.line Length
ME
ONE
—�notsure yes no
MEMMEM
Eno
MEN
am
MEMMEEMOM
ME
kags:, not sure yes no
itorium: n/a yes no
Emma
WEEMEME
ts I yes no iiiiiiiiniiii NOMINEE
cr Attached: soul cis I MENUMME
yes,
J6% OU ?I
C
Notes/ Special Conditions
sk C. 'I'l, N
r
t7147
/agent or Applicant Printed Name PermitpMe s Signature r'
Tj
Y
Sipnature Pleasead compliance statement on back of- rrpit;** lssgingDaie Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File Name

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 andvoid.
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 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 Headauarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applyingfor Permit: Jam L �� �n�t r► N
Mailing address:
�2
Telephone Number:125.2
l certify that I have authorized
to act on my behalf; for the purpose of appll
necessary for the proposed development of
at my property located at A
a{l, w,14 D
r
ng and obtaining all CAMA permits
v
This certification is valid through ' -3� (date).
(Property Owner Information)
Si ature
Print or Type Name
Title, co. owner or trustee for property
y � tors
Date
Telephone Number
A�o�i �n eoa�s���i(esinn � r9 a;l , c0►�-1
Email Address
RECEIVED
APR 01 2015
DCM-MHo CITY

1 i
. i
I
ADJjaCENT !P IA J P PEIPLQMER T 'fEM Pl1'
I hereby certl fy tfitat (own prnPeft, Y adjg(Oxent to u
Property tacated atOwner]
�,
on _�Gt' A s, LBlocR ?�wd�rrd' etc.).
(Wat°�Yy in 2 Cdr-' N.C.
(City/Town and/o CouMy)
The appAcant has described to tne,: 88 shOWn below, the development c
tti P sed at the above
have no objeWon to'thlc proposal. r
t have objections to this
Proposal.
i �—
DESCRIPTION ANDOR 0—
(/ndlWba!�ep d d,�YI
�+� RA"NG'w O~
evelPROPOSED DE
VELO WENT
omeat mr�t Ihn�dron below oretta fi a sited WAY
RECENEQ
APR071015
r tAIVER S t undp, nd that a pier. dodo, oorinlings, at gyop. breakwater, bo se, i� 0199roln' �must be set back s minimum di 95 fro my area of riparian access dens waived by
me, (If you wish to waive these ok,. st i dial the appropriate blank bet w) �''►
I do wish to waive V a1 S` i re uremertt.
i I �
t do not wish to wai the 16, tba r uirement. q�
Q` (Properly Owner Infonnationj Ad ace R
1 rty Owner t 7ormati0nj ,{
st �
P WN..#�— P tQr a Nar»er t N (o
r
j Mailing M �in9AddresS
���e1�•n . �C 28Sto0 , C,
mo M-1�,9 h Number/emaila� �7 7� I
Tel one umberleme;! add
Dad �-
r
' "Valid for one calendar year after signaturg" (P Aug. 2014)
s
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".�� i�nnn r,� S3.LIAS .'I'IIH9NI8dS

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property'adjacent to c J Gt-h✓� r-t—�-�,� cc j'L fL 's
{ (Name of Property Owner)
property located at 10 cn1� ,t ✓ WO, U 614
(Address, Lot, Bloc RC ad, c.)
on Waf-er01c.,�/ + , in 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.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing develo ment must rill in. d cription below or attach a'site drawing)
, IV LA AI d in.
wAY
0 0
1 pD
t-1rfi
I : _ x'
cq
i
/
AIVER S CTION I
I understand that a pier, dock, n oorin-E pilings, b at ramp, breakwater, boAuise, lift, o®r groin
must be set back a minimum diance f 15'frorT my area of riparian access unless waived by
me. (if yo"ish to waive the set ack, y)u must h itial the appropriate blank below.) RECEIVED I
I�I do wish to waive tt e 15' etback re uirement. APR 0 7 2015
I do not wish to waila the 15' setbac requirement. _ , �'' "'�y" " '�
(Property Owner Information) I I �'
/ n 1�
rift- L-6t1 ?- ✓ '-+V)Y1
Prig or Type Nam
ri'IC L O
Mailing Addre s
►J,rW P&rvn NC. 2gS�Q
• Ci5— t d 9 (q 2
Tel ho a Number/ email address
zo15
Dare
*Valid for one calendar year after signature*
nt Property Owner Information)
Print or
Mailing Ad Tess , C'�
City/Sta te i 7 3�
Telephone lN�rr;b06 e/n-a/d�ss
Date *
(Revised Aug. 2014)