Peterson, Terry & Erica

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©C^MA 11 DREDG19, &.FILL,, 66790 A
N11 B C D
11!NERAL PERMIT Previou's permit #
New ElModification El Complete Reissue ElPartial 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
E] Rules attached.
,
Applicant Name If - q
Project Location: County 7e
Address 7, 1 p r
City State Air ZIP
Phonefl, 1) 4" ' 5, E-Mail
Authorized Agent
Affected 0 Cw 9OW E*TA El ES 0 PTS
AEC(s): 0 OEA 0 HHF 0 lH 0 UIBA 0 N/A
El PWS:
ORW:''yes) / no PNA yes / (ho)'
Street Address/ State Road/ Lot #(s)
?,
Subdivision tidyrce'e,r,
City/�� 11 2 1 V. . 1 11) 4 0 ZIP
Phone # ):2 /:5 '1� River Basin
Adj. Wtr. Body /ina—t.)/man /unkn
Closest Maj. Wtr. Body —
Type of Project/ Activity i_c-e
(Scale:
Pier (dock) length WA
Fixed Platform(s) ri 14
Floating Platform(s)
Fingerpier(s) -- - --- - -------- - L141 . ...... . .. ...... ... . ........ .... . ..... ... ...... .. . . ...... . .. ......... ........ ...
Groin length
number
Bulkhead/ Riprap length
avg dotance offshore
M distance offshore -o"
Basin, channel I"
Boat ramp
Boathouse/ Boatlift 60A
Beach Bulldozing
Other —Q6eOrve
Shoreline Length —
SAV: not sure
Moratorium: I
Photos:
Waiver Attached:
EQ01p; �r,%,,, ,, .
A building permit may be required by: k4El See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions A:... 44,1%y. %oo Ae-orwg 4,#h,e a)
m f
Agent or Applicant Printed Name
PermitOfQcer 7 Name
J
Signature Please read.compliance statement on back of permit
Signature
6. 0
Application Feels)
Check#
fi Date,,,
Expiration

M
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 consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
0 Tar - Pamlico River Basin Buffer Rules Other:
El 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
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ I-888-4RCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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

[Y7 AMA / ❑ DREDGE A FILL A
A B C D
NERAL PERMIT
Previous permit#
UNew OModification El 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 inan area of environmental concern pursuant
to 15A NCAC�'
Applicant Name Te- P. RscA Pe 4-e(
❑ Rules attached.
Project Location: Countly
Address / 13 d 6 rPem br tc,., Ct _
Street Address/ State Road/ Lot #(s)
City V A� !ems State NC ZIP'
e
Phone # � / r �t - (3. () ,-� � � E-Mail
Subdivision Alt
Authorized Agent
City L"aLmol'so ZIP k
Affected ❑ CW prEW N4TA ❑ ES ❑ PTS
Phone # -,06 07 River Basin Alle 6143
❑ OFA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Win Body ? JUe jraU� A/man /unkn)
O PWS:
ORWc /yes / no PNA yes / �oJ
Closest Maj. Wtr. Body 965c�
Type of Project/ Activity 7"F(A�c�lc.r
et (Scale:
Pier ¢
Fixed Pi
Float
Forge
"•k Groi
Bul
Basin
I Boat
Boat
I Beac
oth
Shor
SAV
Mo
Phot
Wai
'
■ilillii■i�
i■■■■■■■■I!■
■
■■■■■■■■"■■■L"'
■■■■
■■■■N■■■■M■■M.length
...■■■■■■■■......r..�.
■■■■■®■■■■■■■■■■■
■
■■■
■'tt�
number
■■■■■■■■■s■■■■■■u�■■■
avg distance offshore
max distance offshore
channel
■■■■■ef�■a■�
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■■■■■■r■■liilr/I�■[1II(�1,■i■ii■■■■■■■■■■■■■■
■■■
1�
MEMNON
:�■
:
■■■■■■�■■■■®moon■■
cubic yards
■■■■■■■■��■■■■
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ramp
■■■■■■■■■■■■■■■i■fill■1■I■■■■■■■■il�ilil�i
Vri&iiililViLri■■
■■■■■■■■■_■■■_■■■■,■■I■I■■■■■■■■■■■■■■■■■■M■
rAMEME.2
BulldozingME
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■t
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••
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.
■..■.■■■1■
loom■■■
■■■■■■■■■■■■■■■
line Length
not sure yes 0
■.■■■■■N■■■
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.■...a
1 ■■■■
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`
er Attached: .
��■�■■■■
:SEE
NONE
■■■■■■■■■■■■■■■■L�L�it�iJl�J■■■■■■■■■■■■■■■■'.
EGv�elvlS ,
A building permit may be required by:�Ctiw G•(�i/r+rJZGh �SIF ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions v d cca ig G,,,,, f� / 0 IV6d tJ
Agent,o(' Applicant Printed Name v Permit0 ed Name
SignaturePlease read compliance statement on back of permit Signature
10130
Application Fee(s) Check# rssuinlZLbate Expiration Date

Jun 2916 03:45p EMockSolutions.com 252 6488026 p.1
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date _ 6 (21 1( i.P
Name of Property Owner Applying for Permit:
�e,rr ErICCc'Pe%te[,-s�
Mailing Address:
I Q .3 I Gry-een b ri ar- Pface `10 19 56un d Dr -('VC -
Vass n c EMercdcl We, NC
I certify that I have authorized (agent) Da uk d An larsY) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary
// to
inst,mi or construct (activity) E Z_ _DOdC- " 2- 4 t kagc(cL
at (my property located at) `7 U _ �'} et c (d ��-1MeCCt �,
RECEIVED
JUL 01 2016
This certification is valid thru (date)
�� `� r�M- MHD CITY
Property Owner Signature
Date
RECEIVED
JUN 29 2016
DCM- MHD CITY

CERTIFIED MAIL - RETURN RECEIPT REOUESTED
DIVISION OF COASTAL MANAGEMENT-
A11.0 C"J*e901HPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
y� ffrROwner:
Add
�l ©12SC.,.n i7�
Q 3 M5 (Lot or Street #, Street or Road, City & County)
Agent's (dame # Dayiel ,Anclersop Mailing Address: 5'S6j-
-70
Agent's phone* TZ 11 ? ZS. qn L/ s4 i 4.z. C.. /qe w e: MC. Z&S7 0
I hereby certify that I own property. adjacent to the above referenced property: The individual
applying -for this permit has described to me as shown on the attached drawing the development
they are 71hayse
ing A`desfDtton ordriiiria..itlii tlinen ioCrs musf f nror�ided with=lhys=leattec.
no objections to this proposal. I have objections to this proposal.
if youhave objections to whatis being proposed, youmustnotifytheDivision of ConstalManagement
(DCAV in writing within 10 days of receipt of this notice. Contact information for.DCM offices is
available atht:Uivww.nccoastalmanaaernentnethveb/cm/staffalsftna-orbycalling1-88&4RCOAST..
No remonse is considerad tha same as nn nhiar_tfnn if unu hnvn i.m. n,%ftsta.,r t... t+e.am a u.,n -
WAIVER -SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (if
you wish 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 formation)
1� tr � • l��.w'��-'
aigngwe
Print or Type Name
I 'a 31. G�-=reen bIF% ctr
M rig Address
V rA5.5 nC A% 3 9
City/State0p
9Ia
Telephone Number/Email Address
Date
(Riparian Prope er Information)
Signature" ------RECEIVED
•'"� JUL- 01 2016
Print orType me
ZOO& arrwn:� M- MHD CIT
Mailing Address .
City/StateOp
672,S�
Telephone Number/Email Address
Date
(Revised Aug. 2014)

. '000
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
g1Oti L ti DIVISION OF COASTAL MANAGEMENT.
'JACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Own
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name#. --Dam;J ttY1CAeysC:�1
Agent's phone #: �Z5�zT zS -- cyk.s�(
C -
MailingAddress:_,S'3"bd` /Iww ?O iv+est
i hereby certify that I own property, adjacent to the above referenced property: The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing.'A or.diieriria.wittt d�menstos must tip p[ovidect vitittihts'jci�.
I have no objections to this proposal. I have objections to this proposal:
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCAI) in writing within 10 days of receipt of this notice Contact information for. DCM offices is
available athtbn:(Avwwnccoastaimanaaenrenta, web/cmlsiaff-lisBo4.orbycalling1-888.4RCOAST...
WAIVER -SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 requirement.
Owner in oration) ( aria r party nformation)
Signature
ru �,J . �e fcrsa ►)
t'nnror I ype Name
1'2 3 ( Care 6 r+'a- PIatc
Mailing Address
,40(ss nc V394
City/State/Zip . -
ctIci S
-0I, 0(4-7
Telephone Number/Email Address
L0-14 -1to
Date
Car ( 6 Pk-gry i S
Rrint or, Type Name
31DIOld CcA �sd
Mailing Address . #
?oHry N,c. z7S-oy
Cilyma
- 'S �35-gi*ECEIVED
Telephone Number/Email ress
(Rege*AWD CITY

Page 1 of 1
Address Points
•
Parcels - Updated 6-16-2016
D
Centerlines
NC Railroad Right of Way
0
County Boundary
Other County
call othervalues>
Cart
PIN
Acreage
Parcel Dimensions
Lot Number
RECEIVED
JUL 01 2016
DCM- MHD CITY
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