Lloyd, Andy III

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GAMA il� DREDGE & FILL
A B C;' D
GENERAL.. PERMIT Previous permit #
New ElModification 11 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 15A NCAC
'A
JSrRu es attache
Applicant Name
Project Location: Coun
Address Street Address/ State Road/ Lot
City —t - States ZIP —
R9?41 F-Mn*l
Phone #
Authorized Agent
Affected [I Cw0' 14-EW -47*A ES n-• ;-IPTS
AEC(s): 1:1 OEA El HHF [--1 1H 0 UBA 0 N/A
El PWS:
ORW: yes PNA yes /(n
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) rp
Finger pier(s)
Groin length
,r umber
6ulkhed/ Riprap length
ayg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Subd1visioR---t-----,-
ct k�' tr
City , Phone #
Adj. Wtr. Body - L I"
Closest Maj. Win Body
4
Shoreline Length
n
SAM not sure yes n
Moratorium: n/a yes no
no
In,
Photos: yes 0
no
(
Waiver Attached: yes
11 1 1 J
�1
A building permit may be required by:
(Note Local Planning jurisdictiort')
Notes/ Special Condition
f"t j)�"Jcn
IAO
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Joe.
'AgA4 Applicant Prhie8,Narrfe
Permit Officer's P
**'Please read comp lanpestateeritoribackof
Siattire lanCeSt
gp
rn permit�*
Signaiir
lica
pp,ji6n ee
#
Iss 4(ng ,ate
J
ZIP
River Bask
,-tev ,
All
(Scale:
See note on ,4Db ck regarding Ri I ver Basin ules.,
V
rinted.. Name
Exp1h,7
it!atio " ll ate

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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
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

CAMAr/ 'DREDGE & FILL
...
GENERAL PERMIT
A B C'� D
Previous permit#
New _ El 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 i t
pp
[ ules attached;
Project Location: County_
j
Address Ate„
.$
Street Address/ State Road/ Lot #(s) hL i
tr4�`; 1 i fDe Y'.5 ��rt 3=�_S. i llf,f3✓fti_.
tY� ,:�x�_. r t: j 1b State r �. ZIP. .r
f u,
Phone # (�, >�•,.. ,6 rE-Mail
Subdivision,.
Authorized Agent Y ..s r'I41E
'. ZIP
City
Affected ❑ �W TA 4 ,DES �,.�bns
.
Phone # River Basin ,J y'
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
AEC(s):> -
Adj. Wtr. Body_ s s� O 4 {nat rr+an`�/unki
❑ PWS:
j a
ORW: yes /,po)` PNA yes
�•
Closest Maj. Wtr. Body
Type of Project/ Activity
No
mom
momomimmom
mom
IN
0
mommommmoommommomm
NO
0
MANIIIESINN
Mimi
loommom
momommimmomimmmommim
mom
No
No
0
0
MEMO
MENNEN
Emil
ME
■
CC
_J
Im W.;k
El See note on back regarding River Basin rules.

t r 0
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _ 1 1 �. �J,
Mailing Address:
Phone Number:
Email Address:
:2 I f Q � 6) b 2 a
carn I
I certify that I have authorized r-h L,p 1 1) P
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: It
at my property located at C1 `� �� n 7o.4h `Z ,
in (fA � �) County.
l 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.
Property Owner Information:
Signat
Print or Type Name
©;"i�
Title RECEIVED
t I , 3 1 C�
Date DEC 2 8 2016
This certification is valid through 11
DCM- MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that 1 own property adjacent to N n L LL,c!r 's
(Nam of Pr pe Owner)
property located at I `'l c6 �i �9 �--e p �-+ ti . c
(Address, Lot, Block, Road, etc.)
on C KJ-Jq'- , in P 10 L— 1CN 6 l) i Imo r'-e-S N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
1 have no objection to this proposal.
1 nave objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must f ffin description below or attach a site drawing)
RECEIVED
DEC 2 8 2016
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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property O er information)
(Adj ent Property Owner information)
S-' ature
Signat
P 'nt or Type (Name
Print or Type Name
[218- I S�
Mailing Aaidress
naof -e k G� N Z 7
_ �
Majig Address
. .
City/Sta� ip fl O
�j � �'
_ 6� j..
w
C /S ee��Zip �—L
�r'i �j k6!G
b� ��
Telephone Number/email address
_
Telephone Number/email address
2 . l �
PC
Date
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

hereby certify that I ownproperty adjacent to b � 's
Tt(me of 0, roperty Owner)
property located atho
(Address, L Block, Road, etc.)
on CA -*-a J in i N"e. 1(4jo t ( S ko� . 'S , N.C.
-(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, `the. development proposed at the above
location.
have no objection to this proposal
have objections to this proposal.. .
DESCRIPTION AND/OR 60AWING OF 0ROPOSED DEVELOPMENT:
(Individual proposing development must f. 4p description below or attach a site drawing)
RECEIVED
Z016
_ l
WAIVER SECTION[ AHD
CITY . z
understand that a pier, dock, mooring''"M gs, breakwafer, boathouse, lift, or groin must be set
Pack:a minJ.
imum distance bf t5' from my. area of riparian access unless waived by me. (If you .
wish to waive the setback; you musUhMal the. appropriate blank below.) y
do Wsh to waive the 15' setback requirement. I
j
do not wish to waive the 16' setback requirement.
(Property Owner Information) ( pert
Sig ature Signa
n:JLip PEN
Print orTyp ame Print or Type Name -
N�jling Address ,Mail' g Address
r i na C� j . No � hG r���e � � S 1
city% tate/Zi 2�;� CitylBfate ip
s soffit q 1- 2. /0 .:
O A39
Telephone Nur ber Telephone Number
Date Date
(Revised 6/18/2M)