Moeller, Thomas

WO 9- L-L
.DCAMA/ 6 �(Y 0 7 0 ,tp DREDGE & FILL A B D
GENERAL PERMIT Previous permit #
ONew ElModification El 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 CrIll, 7 1/ f
IQ Rules attached.
Applicant Name~ Project Location: County C' k r I
Address 1 Street Address/ State Road/ Lot #(s)
City _,J",-;W'State tJ(','ZIP _""
Y. rti�ZRP�
Phone# E-Mail
Authorized Agent
Affected
% - I f
P OCW -,1EEW �)PTA _,10ES -.PTS
I
AEC(s): 0 OEA El HHF 0 lH 0 USA 0 N/A
0 PWS:
ORW: yes ItO PNA yes
Agent or Applicant Printed Name
Sighwturz **Please read compliance statement on back of permit"
7 7[7
S 0
Application Fee(s) Check#
Subdivision
ZIP
City- --------
J
Phone # River Basin _jll
(
Adj. Wtr. BodyC-t-ef ,-� n af/man.,`/unkn)
fp
I
I
" ,
Closest Maj. Win Body A- I ­ _�
PermitOfficer's Printed Nam
Signature
Issuing Date'
'7-
Expiiation 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 consistent with the North CarolinaCoastal 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.nett
Revised 08/27/ 14

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: ]20 Nl OA 5 -i� j,A Mo ELF
Mailing address: 101 1 60/ 1 oN woo b G%'
19V �� l� 1V0 L L Slid P 0.5 Am- ZS.SI 2--
Telephone Number: %'� a- 6 Z 2- 4113
certify that I have authorized -b o 1i Ai 15 -� -50 j -5 (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of, el) d e
i
at my property located at R OC KV ITA F_
This certification is valid through-T)p c_ . 3 ( , 7 o i (date).
(Prop Owner I form tion)
b
Signature.
14010AS /00E LL
Print or Type Name
QwNO-19-
Title, co. owner or trustee for property
_ 9 1-2--? l /sue
Date
I`-f--31�-5-69
Telephone Number
W)CIvho, Gam
Email Address
OCT 0 7 2015
DCM- MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -n6 ,6 S AV' 64 AJTW 1 0&Z- , C"^ r<
(Name of Property Owner)
property located at
on
(Wa - - -
andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
*011_ 1 have no objection to this proposal.
1 have objections to this proposal.
ANDIOR DRAWING
.OPMENT
RECEIVE®
OCT 0 7 2015
®CM- MHD CITY
WAIVER SECTION
l 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 15' setback
(Property Owner Information) (Adja WO'Dwrier Information)
11iU' ,JI atui"e'�
a o e l-er te,44 419L! RE;R-13S a`
Print or Type Name Print or a Name
/017t�r�dyc�
PILing Address ailing Address IL
'r�� "yi ll Y�e� C 2"1Z 2rvi0 h/K _ IVY lad' T
• v 6 q � Ci I ke zip AMTelephone Numberlemail address Tele one Imberl email address
rY1o,c t e r u"O o S V
.Date �s- qJmate
(Revised Aug. 2014)
*Valid for one calendar year after signature*

I ' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that l own property adjacent to f9-02 MA5 alU'n4(A
(Name of Property Owner)
property located at 1 ii $—ale SOR V i1AS- --7s.
(Address, L k Block, Road, etc.)
on 11l r 11JOLC. l'1 m. l N . ;<AJ0 Lt� �L— � IE' "S, N.C.
ijWaterbody) W�4 (City/Town andlor County)
The appli has described to me, as shown below, the development proposed at the above
location
1 have no objection to this proposal.
1 have objections to this proposal.:
A NTH A % D T.)o c.G
WIFC�1\JE®
OCT 01 2015
®CM_ MHp CITY
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16 from my area of riparian access unless waived by
me. (if you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
S' lure
r1 e- ,t,
Prin orT a Name Print or Type Name
101 o�T�"c�nl W o a. T j 1 G �► lL15o U l �r-.g
ailing Address 1rlin Addre,
/CIS "OLL 5�toz5� i'`''W9 AJQLU S c e.�Es,
CiW1ate� 1 C / t eM
ju0 a1 s/2 tzS bob$'
Telephone Numberl maY address Telephone IV be l email address
14
Date G �� Y j +V iZa , GC m Date*
sV'1 (Revised Aug. 2014)
";iilid for one calendar year after signature*

I hereby certify that 1 own property
property located at
on
(Waterbody)
The applica t has described to
location.
ltto —1-hOM4.5 i 6yn*-Aia-- b6c-!!fees
(Name of Property Owner)
(Address, Lot, Block, /Road, etc.
in Pi ha. W-n o Imo res. , N.C.
(CitylTown and/or County)
as shown below, the development proposed at the above
I have no objection tolthis proposal.
I have objections to this proposal.
DESCRIPTION AND/Olk DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
p1 aae 3 in
I understand that a pier, dock,
must be set back a minimum i
me. (If you wish to waive the si
i � i i� s GLlPn9► b ul l-ch+e_ad
r��J g
RECEIVED
NOV 18 2015
DCM- MHD CITY
WAIVER SECTION
ig pilings, boat ramp, breakwater, boathouse, lift, or groin
of 15' from my area of riparian access unless waived by
you must initial the appropriate blank below.)
I do wish to waive the I5' setback requirement.
I do not wish to waive Ithe 15' setback requirement.
(Property Owner Information)
Sr re ,
seller
Pr or T pe Name
i D 1 r�tfimn woaol
cling Add
r ►�.p I mho ! 151�oDre s
�'�Il 41 � g3 -.�0gg-
Telephone Number/email address
/ 1 1-7 1115
Date
*Valid for one calendar year
(Adjacent Property Owner Information)
Sr ature*
Roll R h &Ale. i 1 L
Print or Type Name
11 /o Arborvt+ae.
ling Add'mss
2-95'12.T1 ne— kno 115har'ng. NC- Zg'S12
cilylstate
Z5ZYp 240 - 009
Telephone Number/email address
II/�IIS
Date*
signature*
(Revised Aug. 2014)

I hereby certify that l own property a ja
property located at i 1$
on
(Waterbody)
to--1Jh'64 6/y)'1'hr*4.%4o811Er's
V, (Name of Property Owner)
ss, Lot, Block, Road, etc.)
in N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
x_ I have no objection to this proposal.
I have objections to tIis proposal.
DESCRIPTION /
(individual proposing dove
HO DRAWING OF PROPOSEu utvtwrnntro r
f must frll in description below or attach'a site drawing}
10aa_t 'il e, V!
RECEIVED
Nov 18 2015
DCM- MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooing pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distar ce of 15' from my area of riparian access unless waived by
me_ (If you wish to waive the setba , you must initial the appropriate blank below.)
l do wish to waive the 15' setback requirement.
I do not wish to waive 1the 15' setback requirement.
(Property Owner Information)
I
Date
Address
Number/email
Owner Information)
Print orTVa Name
zSs1-z I— 7ingAddress IVY 1osa-
CIt ISlateMp
'41j�-87718
Telephone Number/email address
i t /i f t 5,
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*