Pendergraph, Frankie

CAMA '.DREDGE & FILL
GENERAL PERMIT Previous permit #
ANew I 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 I SA NCAC
El Rules attached.
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Name Project Loc ko
Applicant ation: County r,
Xddress Street Address/ State Road/ Lot
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'A,-#(s)RCity Stater zip 5�u--i
�Phone # Fax # Subdivision
uthorizedAent
-i
ZIP
A Cr
0 Cw
(4EW NPTA -AES 0 PTS
Phone# �511jver Basin
i 0,1� lA.S(-'
Affected
AEC(s): 0 OEA
0 HHF 0 1H 0 UBA 0 N/A
Adj.Wtr.Bod
(n'a-t/man/unkn
0 PWS:
0 FQ
t7S701--
Closest Maj. Wtr. Body —
ORW: yes /�J�l
PNA yes/ Lorit.Ha�g / no
Type Type of Project/ Activity Y
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
_--PyTber
rBulkhea rap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other 09- 1 iN�)
Shoreline Length
SAV. not sure yes
Sandbags: not sure yes
no
:Moratorium: n/a yes
Photos: yes
steno
(tno)
:Waiver Attached:yes
A building permit maybe
Notes/ Special Conditions
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El See note on back regarding River Basin rules.
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Agent or Applicant R inted Name X-
Permit Offider's Signature
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'Signature "Please read compliance statement back of permit" lssui6g0at6 I Expiratibn Date
(Y)c or)-,�nA
Application Fee(s) Check# 'Local Planning Jurisdiction Rover File Name

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 ❑ Other:
0 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 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 comply with 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/ 1-888ARCOAST
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

Name: Frankie Pendergraph
Date: 7/15/14
GP Habitat Sheet
Permit M 64114C
Address: 4708 San Juan Circle
Habitat
SF of Disturbance
SF of Disturbance
LF of Disturbance
LF of Disturbance
Open water
288
288
N/A
N/A
shoreline
374
374
AUG 0 5 2014
DCM MHD CffY

' A4,a
.�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director
Secretary
Date
Applicant Name Ucp wlaivef &o1er % 1 &9
Mailing Address D • 60�
I certify that I have authorized (agent) 4-Apx m /Ci to act on my behalf, for the
purpose of applying for and obtaining all LAMA Permits necessary to install or construct (activity)
sU ul4he4, / DC at (location)
Cam.-► o _541 Tyaltlt G'Xoore lewol&Y //'y
yyjk MCE1VZD
AUG 0 5 2014
// mcMMHncrTy
This certification is valid thru (date) !o - /5 " 1S
Signature��.
JUL 15 2014
DC&1•XqD C.qy
400 Commerce Ave., Morehead City, NC 28557 One
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net NOrthCarohna
An Equal Opportunity 1 Affirmative Action Employer �atub �LL�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I ownproperty adjacent tof'ki9iuX 1� ��/C�� �eN e r ya J
Q/ So'{')
(Name of Pro erty Owner)
property located at �� g 5)W J g11A1 Ll2
(Address, Lot, Block, Road, etc.
on An/ �%�e CA4V*'I in I%a; eaV 6 V , N.C.
(Waterbody) (City/Town and/o County)
The. applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to this proposal.
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)
Z
AUG 0 5 2014
—--DEC
RY
WAIVER SECTION"
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
wish to waive the setback, ou minutia he appropriate blank below.) }
I do wish to waive the 15' setback requirement. JUL 15 Z014
I do not wish to waive the 15' setback requirement.
DCMMtIDCITY
(Property Owner Information) (Adjacent Property Owner Information)
Si nl
of ` re SiValre
►vaor ra �m �tx�fe5do -�
Print or Type Name Print or Type Name\
©; bl9z- Ste, JMA-1 CA*r
Mailing ddress Mailin ddr s
City/State ip City/State/Zip
Telephone Number Telephone Number
7- 5-AVAI
Date Date-
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
• I hereby certify that I own property adjacent to PA'wlyklcE A'4 L' � 0�
Name of PropertyOwner)
property located at 1-I'M ;RA Ty1,,V
(Address, Lot, BlocK Road, etc.)
on %�lt/y�lp� C�tiL , inyie1�Glca' f�� , N.C.
(Waterbody) (City/Town and/o County)
The applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to this proposal.
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)
xed
.
AUG 0 5 2014
DCMMHD CITY
K Z�F tut mM f A, 9 �co
WAIVER SECTION'. !.
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.)
do wish to .waive the 5' setback requirement. JUL 15
2014
I do not wish to waive the 15' setback requirement.
ir�,�yf (Prope Owner lnfor n) I�Prrty Owner Informa io
Sign e Sign tur
Print or T e Name Print r Type Name
Mailin ddre MailnF Ad ress
City/State/Zip C
i
t
y
/telLi 7�
/Q -155 -0�' Y
Telephone Number Telephone Number
Date Date
(Revised 6/18/2012)