Pate, Gayle

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit #
New 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 an area of environmental concern pursuant to 15A NCAC
- Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City------ - -- State------ - ZIP
Phone # (- - )— -_ _ Fax # ( ) -----
Authorized Agent
Affected CW EW ❑ PTA ❑ ES - , PTS
AEC(s): OEA HHF ❑ IH ❑ UBA L' N/A
PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Type of Project/ Activity
Pier (dock) length__
Platform(s)
Finger pier(s)
Groin length
number -
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards-_ -
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
ti
Shoreline Length
�t (TTV�'�
SAV: not sure yes no _
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
D cm-mpcm
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s)
Subdivision
City - --- ----- -- ZIP --
Phone # (- - _ _) - - River Basin
Adj. Wtr. Body -------------- _- nat /man /unkn
Closest Maj. Wtr. Body- - - - - - - _-_ _ _- - - -- -- _
(Scale: )
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local PlanningJurisdiction Rover File Name

4
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 andvoid.
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
Neuse River Basin Buffer Rules
0 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 Quality. Contact the Division of Water Quality 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
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters.
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

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Applicarit:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Appled for.
Disturbance -total
'includes any
anticipated
restoration or
temp impacts)
FINAL 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
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill Both, ❑ Other ❑
Dredge ❑ . Fill❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ ' Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ 'Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ .Fill ❑' Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other El
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ . Fill ❑ Both ❑ Other [I
Dredge ❑. Fill ❑ Both ❑ Other ❑
1tCEIiD
APR 2 2 2014
]DICUMMMY

I hereby certify that I own pr
property located at 1 b(�,
adjacent to
CLll h
(Address. Lot,
in
of Property Owner)
I
t..aan..,.,.,rt (Gltyrrown 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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(lndhddual proposing development must fill in description below or attach a site drawing)
1 WAIVER SECTION
I?understand that a pier, dock, mooring pilings, 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
�1 I do not wish to waive the 15' setback requirement
Owner Information)
r3WWK;-=
Print or 1)pe Name
Mailing Address
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City/State2l
G I a- ,4ALt-a(,OQ
Telephone Number
/I3_/IL
(Adjacent Property nformation)
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Sigh m�
Print or T je4V.
/7Z-��
n
iling A�
City/Stateop
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Telephone Number'
- / Z — J I -
Date bate
APR 2 2 2014
(Revised 6118)2012)
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