Michaels, Paul

❑LAMA / ❑ DREDGE & FILL
A B
�C - D
GENERAL PERMIT
'� Previous permit#
`-' I
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and
Natural Resources
x'
and the Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC
Applicant Name t" u'�� j 1 �-t lti �C '
❑ Rules attached.
Project Location: County
Address.
Street Address/ State Road/ Lot #(s)
City t�, 1(` ,� .l State ZIP ' % (
'>" , IR I. ' l
Phone # i C r �7 (P _ _Mall
Subdivision I r
Authorized Agent
+ `,, I # ZIP
City + t
Y
❑ Cw 4 gw b!]PTA ❑ ES ❑ PTS
Phone # ( ) 4/ ivec Basin �' ? l �... L
Affected
❑ OEA ElHHF ❑ IH ❑ UBA ❑ N/A
AEC s() :
t t� ,11t�.'��
{ ) (f �, ' i 7 �? t } - man Jun- )
Adj. Wtr. Body s = (nat /�cn
❑ PWS:
! % PNA
Closest Maj. Wtr. Body
ORyes es o yes `n
/
Type of Project/ Activity ~ IV %t t. i ! "4._I �' $: i'�� - , ; % , .
(scale:►
Pier
Fixe<
Float
Finge
Groi
Bulk►
Basir
Boat
Boat
Beac
Oth(
Shor
SAV
Mor
Phot
Wah
r pier(s)
i
NIME
i length
■
M
No
number
avg distance
MEMO
max istance
channel
OMEN
�:
No
.....
ramp
.tea
WIN
Elm
o
OMEN
MEN
No
'
Im
e.1111
:.
M
EMMEMN
NEON
_
�►n's
m��1
�M
:ate:not
ENEEM
SEMEN
1100�wwirs
MEMEMMIMMEMEM
sure yes
A building permit may be required by: i`t't� t�. fA�`1 l r" i ! % ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Pfi 1J
Agent or Applicant Printed Nre f PermitOfficer's Printed,Name -
S' nature . ;�`)* Phase read compliance statement on backof permi ** Signature t ' �--� �`�'=-" _
�il J� rl
0�
Application Fee(s) Check # Issuing Date 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
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 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 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 Citv 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.nett
Revised 08/27/14

Y'�

s
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: P0+W L
Mailing address: 3699 e6
-tLC 2%0
.2
Telephone Number: CIO (.a 4P b i !
I certify that I have authorized 15141'-sy grzoo -S (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all LAMA permits
necessary for the proposed development of''4'r'
at my property located at _ 2 3 �. �tN �� tj7 J---J77C—
This certification is valid through -7" 3 ! — / 15 (date).
(Property Owner Informatio
t
S atcre
PAU L a. M,
Print or Type Name
Title, co. owneror t stee for property
RECEIVE®
Da a SUN 0 8106
�0—lr-? Q
T lephone Number
Email Address

a)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to T" apt 1 !M! AO-415 's
(Name of Property Owner)
Property located at Z t 3 CjGt�,/Vl-Ct� � E'
(Address, Lot, lock,c �3
Road etc.)
on —Mom N i��! , in `r;r eac� N.C.
Waterbc d) Xitv/Town and/or cn,o.,t.,►
The applicant has described to me, as shown below, the development proposed at the above
loca 'o
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
Ondivldual proposing development must flll In descriptlon 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback requirement.
(Prop
r I on) (Adjacent Properly Owner Information)
LJ�Q
Stg'J�WL
f C 4L� Si lure*
Pn Gr�TWype � � U ,� �I��rQ
• PHor rypa CIA r"
of
*�
MaAddrgss! ` �� L �� �,► dress' ► L C S te2i _ / I' s� 7-
0 ep a Number e i $ddre � to ne Nuf7barl email address
t
Dare �4t — ' '� ? J g
sLk.
*Valid for one calendar year after signature* vlsed uq. 2014) ! C awL
RECEIVED
JUN 0 9 20b

M
A
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I i;ereby certify that 1 own property adjacent to
C�iK-� W1IG�Iut"�S
is
(Name of Property Owner)
property located at 213 f3 t� ayy(-e Ltd D r
+ l (Address, Lot, Block, Roadr etc.) t
vA -e' R v in _ t t"t'C R'1t t -t�'e cWt, _V N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: '5Q-'0 (vo s Mai;ing Address: 5eP Pro 5,.14 Ct r
Agent's phone #:1,02 — ip4lr :3 1I 2-- _ N6vP o r+ A e-
NelShe has described to me as shown below the development he'she is proaosing at that location,
and I have no objections to the proposal.
-----..._..___---------------------------------------------------
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a sate drawing)
If you have objections to what Is being proposod, you must notify the Division of Coastal Management
(DCtrf) in writing within 10 days of receipt of this notice. Contact Information for DCM, offices is
available athttirr�vv.rxccn�,t�a;rr>rninz�r?tnet"sflh.t;t,d�tal-=itfr orb callln 1. _. y g 886-4RCOAST.
NO_rinponse Is considdr(?d tho Same a5 n0 Ohfnrfinn if vnir hav::./,ono n. itifP� t i,,.
U
T"er in ur ation)
Srgnstun. �-
O-:
Faint or cr ; yea Name -
iWaillnp,4ddress
owner Information)
,�f G G t �-*•I t rr .S" t � {�' Prat'
pent or Type Name
?_?i 1 .�.
Mailing Address » ..
nyrstarsrzap------
r
Telephone Ivumberl Emad Addr ess
(Revised: Aug. 2014)
RECEIVED
JUN 0 0 20b
I?- O-Omp 94' 1`