Newman, Howard

PCAMA C1,113REDGE & FILL
Ir
A B D
P�ENERAL PERMIT
Previous permit #
Lf ew ElModification ElComplete 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 I SA NCAC
Applicant Name
Project Location: County C(k �Rules attached.
Address
Street Address/ State Road/ Lot #
City —a-L- 1; t k__ �'•: State r Y ZIP
Phone# IQ -Mail
Subdivision
Authorized Agent i �A
city. ZI P
El CW bkEW 7VIPTA YES 0 PTS
PhoneRiver Basin ram"Affected
AEC(s): 0 OEA 0 HHF ON 0 UIBA 0 N/A
Adj. Wtr. Body Z i (nat /nia /unkn
13 PWS:
Closest Maj. Wtr. Body— -
ORW: yes / {no ' PNA yes/ n"o
.1
Type of Project/ Activity "'k
(ScaleAU:
Pier (dock) length r 10
./V
Fixed Platform(s) '---* I
Floating Platform(s)`
Finger pier(s)
Groin length
Bulkhead Riprap length J A
A
avg distance offshore
max distance offshore
Basin, channel
cubic �
Boat ramp.
Boathouse/
Beach Bulldozing
Other
J� Mi EN MMI
M
mill 11111
Shoreline Length M MMM
lfllll�—'il�t1:II ICI
SAM notsure yes 7
Moratorium: n/a yes
Photos: Ires") 00
Waiver Attached: no
I Ill I T
7
I
A building permit may be required by:
T
see note on back
regarding River Basin rules.
(Note Local Planning Ju i nsdic"t*, n
r
Notes/ Special Conditions
A� di
kll
or Applicant Prioted NaTe '
me
PermitOfficer's Print Na
"Signature Please read compliance statement on back of permit
Signature
Application Fee(s)
Check#
Issuing Date
Expiratio4 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, 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 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/ 1-888-411COAST
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. nccoastalmanagement.net/
Revised 08/27/ 14

Y�

Name of Property Owner Applying for Permit:`
Mailing address: _
Telephone Number: 2
I certify that I have authorized ---"
to act on my behalf; for the purpose of
necessary for the proposed
' (agenVcontractor),
i and obtaining all CAMA permits
at my property located at , _ _ ' /
i
f- (date`
This certification is valid through
(Property Owner Information)
�Sign`ature
--
print or Type Name
J A
irtle, co. owner or tnistee for propeRy
Date
Telephone Number
n ie i
Email
RECEIVED
JUN 0 21015
RECEIVED
JUN 0 41015

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to x) 's
(Name of Property Owner)
property located at 3 ��,� eaty
(A dress, Lot, Block Road, etc.)
on L, in C , N.C.
(Waterbody) Y (City/Town and/or County)
The applica as described to me, as shown below, the development proposed at the aboveRECENED
d'V
location JUN 0
1 have no objection to this proposal. 2 1015
f? 'f~"f:w, Elks �!It
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
b�u.�
�449A' L-
.�o tits
LAe�
WAIVER SECT qv
It 17� bSr' R
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or broin
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'l5' setback requirement.
I do not wish to waive{ the 15' setback requirement.
(Property Owner Information)
Name
ailing Address
Ci /Sta ip
Telephone Number/email address~
Date
*Valid for one calendar year after signature*
(Adjacent P p wrier Information)
Signatz
Print or T e amf
Maijing Address RECtED
yew tern, AIL-,�9, ` JUNCity/ tat i01015
s! 4i4 -4)1 & MVA�rrtt
Telep on Nu ber/email address
1 IS
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
l herebycertify that I own property / �� fy p p rty adjacent to �_�,n�J /I16.1/» 4.Al 's
(Name of Property Owner)
property located at -30 S ,&o 016/
Address, Lot, Pjock, Road, etc.)
on _tea 1A,8 4 �i/1�_� � in AleGcls�y , f , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
scat'
I have no objection to this proposal.
I have objections to this proposal.
uCQtorutr 11UN AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill -in description 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 waiver WVED
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
JUN' 0.2 1015
&—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)
41igyature ! Siggn�ature RECEIVED
Pitt` / I M 4�
cysll2cc•�
not or Ty a Name Print or Type�pgme 9 JUN 0 41015
cos pip � � ,tl
Mailing Address
Q Stat
[
TJ�. 'r_
Telephone Number/email address
Date
*Valid for one calendar year after signature*
5
v v c iTV UI� La )1E1INtIHCA71/
Mailln„q Address
City/State ip
-2, S2- —/0D.2- C c c-ra-w coY't ,
Telephone Number/email address r
Date*
(Revised Aug. 2014)