Page, Jimmy

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41CAMA El DREDGE & FILL TO 67431 A :G-ENERAL PERMIT Previous permit # B D
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 ari area of environmental concern pursuant to I SA NCAC
'Wleq, rAttiched.
Project Location: County,`
Applicant,Name (AP ty( t i
Address_ treet Address/ State Road/ Lot (s) Z
City State �"iJ' ZIP
E-Mail
Phone # (_1 YI) Subdivision
Authorized Agent
0 CW
*EW
)�WA
Affected
AEC(s): 0 OEA
El HHF
0 1H
El PWS:
le-1.
ORW: yes K6
PNA
yes/
Type of Project( Activity
Pier (dnrk)JPn9tb 1-1
Fixe_�
Float
Fing
Groi
Bulkh
Basin
Boat
Boat
Beac
Oth4
Shor
SAV
Mor
Phosi
Wah
city
El ES 0 PTS Phone#
0 USA 0 N/A Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP X
ver Basin 1
(Scale:
Platform(�)�i
!eng.6
number
IN
NINON!
ead/ Riprap length
MIN
IBM
avg distance offshore�
max distance offshore
ME
aw"J
w A
a
,channel
MEN
cubic yards
ram
See note on back regarding River Basin rules.
A"bu
( Note Local PlanningJuriscli
Notes/ Sqiecial Conditions
fl
A k,
)t
Agent ooAppolicant inted Name Permit Offi' d s Printed N e
C
Sigkiture F-I#ase read compliance statement on back of permit Si at
t
Check # Issui g Date Expiration a e

A
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 Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules
0 Neuse River Basin Buffer Rules
Other:
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 howto 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.nccoastaimanagement.net/
Revised 08/27/ 14

CAMA / ❑ DREDGE & FILL 67431 A B C
GENERAL PERMIT #'
Previous permit # ' c- -
ew ❑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 ad area of environmental concern pursuant to 15A NCAC o i
ule hed.
Applicant Name Project Location: Count
Address: ` _ _ ! reet Add ess/ State d/ Lot (s)
i
City State ZIP
Phone # ( E-Mail Subdivision -----�
Authorized Agent p•--i i City ZIP
Affected ❑ Cw TA'' ❑ ES ElPTS Phone # iver Basin
AEC(s) ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A i
❑ PWS: Adj. Wtr. Body nat man unkn
ORW: yes / PNA yes Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length'
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) :-�
Groin length .---
number
Bulkhead/ Riprap length
avg distance offshore"'
max distance offshore —
Basin, channel
cubic yards
Boat ramp
Boathous Boa ift '
Beach Bulldozing
-
OtheA wlk.—- --. l
Shoreline Length
SAV. not sure yes no
Moratorium: n/a yes
Photos: yes o
WaiverAttached: ,y
A building permit may be required by-
( Note Local Planning Jurisdiction
Notes/ SV@cial Conditions, j
r�
Agent WpplicaqLWnted Na
Sigt(ature "ftase read compliance statement on back of permit"
/) 'e' f '�i R;' Ci t (7
'i
ss
(Scale: +t / — ao }
�. ❑ See note on back regarding River Basin rulesuchrj"O-All -Rat
1 ;a iM n
'ermit0 is 's Printed a e f
Acation Fee(s) ,Check #
i (7-
Expiration a e

Applicant:
Date:
� C� 7��
Describe elow the HABITAT disturbances for the application. All values should match the narne, and f measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Miturbahce.total
includes any
anticipated
restoration or
temp impacts)
FFNAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbaribe.
Excludes any
restoration and/or
temp impact
amount)
Dredge El Fill El. Both 171 Otherq
F
Dredge ❑ FIIITI Both 171 Other n
t
Dredge El Fill El Both n Other El
Dredge ❑ Fill [I Both 171 Other El
Dredoe ❑ Fill El Both El Other D
Dredge ❑ Fill ❑ Both [I Other El
Dredge El Fill El Both El Other El
Dredge El Fill [I Both El Other El
Dredge El Fill [I Both El Other F1
Dredge El Fill [I Both [I Other El
Dredge El Fill 0 Both f-1 Other [:1
Dredge ❑ Fill 1771 Both El Other El
Dredge El Fill El Both El Other E]
Dredge 0 Fill El Both El Other 0
Dredge El. . Fill D Both El Other D
RECEIVED
JAN 2 9 2015
P"'PW-M, no. Mf*

1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 ownaproperty adjacent to
property located at J
I
C� (Address lock, on C.- V i ,in �:�Ud
, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I 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)
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 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.)
L— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
4;2�� #
Si ature
Print or T�j Name ,t j
.41
Mailing Address
_ S , 0ll>!! �4�3T—T I?• 'ZFS/16
City/State2ip
2S2-'3iS�
Telephone Number l email address
Date
(Adjacent Property Owner Information)
Si re*
Print or Type Name
b/D /f"'0<-
Mailing Addr ss�,,�� Z Y
Crfy� /� t �p J ! p 6
12 d�3d�
Telephone YumbeV email address RECEIVED
T, !C 2�i Z'—
Date JAN 2 8 2015
(Revised Aug. 2641)MHB CITY
*Valid for one calendar year after signature*

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
is L�
I certify that I have autho ' ed (agen T1 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Owner
Date
RECEIVED
JAN 2 9 2015

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to bi , 's
(� t � „�`.,,' `{Name operiy O ner)
property located at `�-•-7'� L t
(Address, Lo g�, d etc.
on in 1 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
•� I have no objection to this proposal.
I 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)
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\ I„- I do wish. to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner InformPa
n)
Print or Type Name
> q .s C117W t IA5 i � z1v
M fling Address
City/StatefZip
Sa -
Telephone Numberfemail address
7 - /S- Z C
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
sig;atu
Print7�Ty I Name 7
Mailing A dress�n
a �
City/State%Zf
Telephone Nyrmber(email address
i
Date*
(Revised Aug. 2014)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
�'�� ��0_� (�� � I j• , v� RECEIVED
JAN 2 0 2015
DCM-MHD CITY
I certify that I have authorized (agent) 1 1� `--�� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) - 1--Ys ...,
at (my property located at)
This certification is valid thru (date)
Owner
Date
RECEIVED
JAN 2 0 ?`Ei ;
E)ewmHD CIT"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (��1� 's
property located at
(Address Lo lock, R d etc,
on ��4 —,in it i'J , N.C.
(Waterbody) (Cityfrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANWOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
. RECEIVED
JAN 2 01015
WAIVER SECTION DCM-MHD
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- - I do wish. to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Property Owner Information)
Si a�" # /2�
ature
f -4'y X",_/ & .. &I
Print or Typ Name
I3in
5' ff1%G>r`
Mailing Address
citylStatea.
P_ 3` 2 n/-y 2 +�
Telephone Number/email address
lI Y=1 r iC
Date
(Adjacent Property Owner Information)
Print or Type Name
_
Mailing A§Idrffssrba� i
City) tateMp
2 T;? --- dx3e a I 0 6
Telephone Number email address 29 VS
ANN
Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature'
RECEIVED
DCM-MHD Cif'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tolti
(Name operty ner)
property located at L,_,, CA t
(Address, Ltm�*�
on ( � in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
•� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
R
o
RFCF/�Fo
0?0��
✓,qN2
AN:41,
ti11
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.)
ii I do wish. to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informa ' n) (Adjacent Property Owner Information)
Print or Type Name Prinf o Type Name
M ng Address Mailin A dress
City/State/Zip City/Sfatelljp
Telephone Number/email address Telephone N mber email address
I /S- g .- JAN 29 ?n`
Date Date*
Chll.jylHD
(Revised Aug. 2G?14)
*Valid for one calendar year after signature*