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LAMA / El DREDGE &FILL N*f 65481
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GENERAL PERMIT Previous permit #
1New ❑Modification ❑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 envi;pa!�nmentconcern pursuant to 15A NCAC
{ 1i� {IN ules atta hed.
Applicant Name ' Ff-171�° i ' .�'� f I` ''' Project Location: County ( r':i.'C,t'.
Address.`:", Street Address/ State Road/ Lot #(s)
city "I-r 1 e; ,,
Phone #::)
Authorized Agent
Affected ❑ Cwi
AEC(s): ❑ OEA
❑ PW5
ORW: yes % nog
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City
Phone # ( ) _"-." River
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Closest Maj. Wtc Body i," l.f
Fixed Platform(s)
Groin length
number
ayg distance offshore
Basin, channel
ON
cubic yards
Boat ramp
Boathouse/ Boatlift
Other
NINE
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Photos: ye:
Waiver Attached: yes
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Permit Officer's Printed
' Please read corripliatice statement on back of per i e*
eels) Check #,

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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules El 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 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.nccoastaimanagement.net/
Revised 08/27/ 14

CAMA / ❑DREDGE &FILL`
A B C D
N EAL TERM IT
Previous permit # _
New ❑Modification ❑Complete Reissue
EDPartial Reissue Date previous permit issued
As authorized by State of North Carolina, Department of Environment and Natural Resources ,. r 12az
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and the Coastal Resources Commission in an area of enviro ental
concern pursuant to 15A NCAC '
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Applicant Name
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` i Project Location: County
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Phone # O `"� River Basi I VIP
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Notes/ Special Conditions AIIA
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A!gen orA licant P 'nted Name_ Permit Officer's Printed
Si tur * Please read compliance statement on back of per it** Signature
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Apph6#6n. Feels) Check# Issuin Dat ! Expirati n pate
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'06/11/2015 11:13 FAX [phone] BOPC
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date (01i 011.5
Applicant Name PIIC`SGa_ CbRF©1ta!DtS� APA..,"
-� -
Mailing Address M >r*)L 3(56
John E. Skvarla, III
Secretary
X certify ti at T have authorized (agent) ,Dj_ aCA'fito act on my behalf, for the
purpose of applying for and obtaining all CAMAi Permits neeessaiy to install or construct (activity)
This certification is valid thru (date) 1T;i1�3j
Signature
400 Commerce Ave.,. Morehead Clty, NC 28657
Phone: [phone] t FAX; 2522-247.3330 Internet: www.ncxoastalmanagamentnet
An Equal Opporbriw tAAinn30ve krop Employer
RECEIVED
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l" urdorotent thato plat, ,doclt� th1004nU Vgingo, realavj►a3er, .boathoUrm, jlfk, orvvPp -must be-.W.
Wok e,.mir imum i)
di arl�e of "f 5� cmm 4r '!� "+ P an °access t�rwwaivat� y ,��. (if you
wish -tv Wahb ft..•'�6 W� i YOU must lottial ttle§,00ptppn�.e 91ank bedW,
I daciett! d. �raivt the 4 �'eibai� rsgu�ro'iYrent.
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(Rpv000 0184012)
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VV. ib/rWAW L4.•V •hP LJL WSO V17V -WAv
thereby certify that I own property adjacent to A S' R o1ltr
lama ai
. ar;tp8tty located st
Lot;
on B4C-rile !�Mt� in PIS 0RowrManctla
(Waterbody)
The applicant has desodbed to me, as shown below, the development proposed at the above
tCgtiCn.
.man ..- I have no objection to this proposal.
I have objaetions to this proposal,
DESCRIPTION AND/C0RDRAWIN(3 OF PROPOSED POEI.APMENT
(Individual proposing development must 011111 desedplion ba?'ow or attach a sft- drawing)
WAIVER Sf&Ti' i
t understand that a pier, dock, mooring pilings, breakwater, boathouse, tiff. or groin must be Get
back a minimum distance of 15' from my area of dparlan access unless waived by me. (If you
wish to waive the setback, you must 111tlal -I11e appropda+e Wsrk below.)
I do wish to waive the 16 setback requirement.
t do not wish to waive the 15' setback repulrerrient.
SProperty Owner Informatl*n) (Adjacerrti Pro arty ( Wn0! !nfor:.at;on)
Sri a MOM CM
t. w Z CA % e •• g.
pltnf or ?Yoe Hama
Print—
maitiny Address
.f%CLA&''n G
Cify/5t6te2ip
TeteRlrone Number
Data
;Revised V14WQ f a)
RECEIVED
N 17 2015
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