McCall, Randy

'NTO
0 CAMA 13 DREDGE & FILL
GENERAL PERMIT
Previous permit # A B
D
EINew ElModification E]Complete Reissue ElPartiall 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
Rules attached.
Applicant Name-
Project Location: Coun
Address
Street Address/ State Road/ Lot #(s)
City-t 1 p, State L,zip z;
Phone # E-Mail
Subdivision
Authorized Agent S
city zip
ECW 5LEW brm SEES EPTS
1'
Phone # 1A River Basinr
Affected
EOEA 0HHF ElH 0UBA EN/A
AEC(s):
?I "
Adj. Wtr. Body (nat iman./unkn)
0 PWS:
Closest Maj. Wtr. Body
OIRW: yes / po PNA yes/ no
-ating Platform(s)
ger pier(s) ___
in
-length
number
khead/ Riprap length
_';1g distance offshore -
max distance offshore
in, channel
cubic yards
ramp
house/ Boatlift
MEN
N NN
PIPM,
h Bulldozing
NN
her—
relinel-ength
E
-not sure yes 'no.)'�Nn
iratorium: n/a yes
tos: yes Ano
er Attached:
��
i
ii
gm��
CCC
��C'
Agent or Ap�licant Printed Name PermitOfficer's Printed Name
Signature Please read compliance statement on back of permit" Signature
Application Fee(s) Check # Issuing Date
p
Expiration Date

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
landowners).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify thatthis 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 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/ 1-888-411COAST
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

p.2
V
N.C. DIVISION OF COASTAL. MANAGEMENT
AGENT'AUTHORIZATION FORM
Date Z 1e /
Name ofPropertyOwner Applying for Permit:
Mailing Address:
!1� ,rl 1
I certify that I have authorized (agent) rr L c % �- �° � to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) r�
at (my property located at) Z,0.T as�i�/ ice
This certification is valid thru (date)
Property Owner Signature
G
Date
RECEIVED
JUL2�^10��-15��TT
'�ilM_r!JS 7"I!"Me
iS—

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I - hereby certify that. 1 own property adjacent to
y-
(Nam of Property Owner)
gym•&W&M=.M
(Aaaress, L.ot, 31 .k, Road, etc.)
on
in 1CiT L - t1-
(Waterbody) lcitwrowrn andlor
s
The applicant has described to me, as. sliovin below, the development proposed at the above
coca. on.
I have no objection to this proposal. '
I have objection's to this proposal..
DESCRIPn0N'ANb10R.-a.R *1 _q OF PROF'O$ED UEVELOPMEWT
Andivicfual proposing develapmbnt-- pi rs fill in descrip'6on below 'ratiach -a sife drawing)
Cc�,1
WAIVERSECTION • y
I. understand that a pier, -dock, mooring`pilirtgs,, blre
" Wi +bter, boathouse, lift; or groin must.be set � ;
back a minimum distance of 15' from my..:area.of dparian.access unless waived by me. (If you 3
wish to waive the setback, you m.ustJdltlal the apptopriate blank below.) j
I do wash to.w.a1v the 15'set6ack requirement.
I do hotwish to waive the 15'•setback requirement.
(Property Owner Inform io,n) (Adjacent Property Owner Information)
414
S ndztire Signature
Print oor• Type - Name n .Print or T. ps Na e
;2 n Or.,.�t
M 'ng Address ' Maiing Addres
Cify/State�Zip Cityrstate/Zip
Telephone Number Telephone Number
7A 2•�2 G f �-
Daie Date
(Revised 6/181201.2)
i<e�.tivtu ..
1 = -
JUL 2 S 205
7

p.4
ADJACENT RIPARIAN PROPERTY QWMER_STATEMFNT
I hereby certify that I own property adjacent to ­4
1k I I of property Owner)
on , In
(Witerbody)
N.C.
andfor b6iinty)
The applicant has de="bed to rnb, as -shown below, the development proposed at thb above
loc
I have no objectiori to this proposal...
I have objections to this proposial.
09SCRIP710WANWOR DRAWIMS' d): PROPOSED DEVELOPMENT
(Individual prbposftigAcievelopinintmus*'t-fillin aresiripijonhatoworafbc'h a site drawing)
............................
iv z
A.
71
WAMVER.St-CTION.
I understand that a pier, dock mooring boathcuse, lift; or groin must be set
back a minimum distance of 15 from my.. area of dpjarlan access; jnless waived by me. (11' you
wish to waive, the setback, sHriltidl the aipprapdate, t)�VnTK below. 1 you tn,u
I do wash to waive the ITsetba6,k requirement.
ldo;not wish to waive the 16 -setback -requirement.
A
(Property Owner Informatlon)
Print or Type Nama
�ggAddess
Telephone NurnEer
Date
M
t or
. A
RECEIVEDi
JUL 2 9 lot
(ROVISed rIU2012)

07/20/2015 17.12 FAX [phone]
NCCOAST COHMNICATIONS
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RECEIVED
JUL 2 9 1015