Piner, Jarvia ( David Duke)

CAMA / 0 DREDGE & FILL
N 0"
0 67567 A B
1 CrC D
ENERAL PERMIT
Previous permit #
New 1:1 Modification ElComplete 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 environm ntal c eC'rn
pursuantltp I SA NCAC
Rules attached.
ti
13
Applicant Name
Location: County
r019 j
Address
Street Address/ Stat Road/ Lot #(s)
City State LLLL
ZIP
%
Phone # Zh -_ ail
Subdivision
Authorized J
Agent, It I (.,-I
city O ZIP
El CW 91 El EW PTA OES PTS
Phone # )River Basin ii0
Affected
OEA 0 HHF 11 '1H El UBA 0 N/A
AEC(s):
fI
Adj. Wtr. Body(nat
Aa
ORW: yes/ rho FINA yes/
Closest Maj. Wtr. Body
I
Type of Project/ Activity f 1 4
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.,�oallift (d)oi(�
/t'
Beach Bulldozing
ICXher—
Shoreline Length J4
SAV: not sure yes (Q'n
Moratorium: n/a yes
Photos: yes elrO."'
Waiver Attached: yes no I F
A building permit may be required by:
Note Local Planning Jurisdiction ,)
•
Notes/ Special Conditions V
Agent ofoplic nt Printpd!�Name
(Scale:J
Ej See note on back regarding River
Y
PermitOfficdr's Printe8 Nan�.,('V
sin rules,
S,ignatupe,/-,,t06se read compliance statement on ba4of permit" Signature
'Application Fee(s), , Check # Issuinj Date

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 I) 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:
0 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 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

P�
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: \j4-. <. G
Mailing address:
Telephone Number:
l✓ -�
I certify that I have authorized r' 1(�r"� 1 l��c��� �SoN V(agent/contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
2915
necessary for the proposed development of CK-1 L, �-� � �
r
at my property located at e� , �� � I i1 L - �-+ t�GL -, (lUC-
Z-
This certification is valid through
(Property Owner Information)
E
3�
f Signature
Print or Type Name
Title, co. owner or trustee for property
Date
Telephone Number,;
Email Address
(date).
RECEIVED
JUL 31 2015
Ha k,�4#
t

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 17— ` `/�5�
-
Name of Property Owner Applying for Permit:.
Mailing Address:
2FCFi�,EO
I certify that I have authorized (agent) 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)
Property Owner Signature
Date RECEIVED
JUL 3 12015

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT

ADJACENT MEAPIAN PROPERTY gMER$TATEMENfT
I. hereby certify that. I own property adjacent to
((Name of Prope Quvri®r}41n
. ...'.. .. ....Wry+JY+B.sJY-'1'.`i�i�i.�iu.r..{www.RT • "4`�._•l-: �����' s ,._, :�19 • . .7r•�5-.� �µ'....-....o. 'sue' ..�...•.�....�,_..
onro
(We"0ody) (C1tY and/or Coui�iy)
The. applicant has described, to me, as .ehown below, the development -proposed at the;above
location.. e
I have no- objectioh.to this proposal...
I have objections to this proposal. • '.
131*SCPJPT . N,Af�DtdR'QRAIMNG O>r PROP684D DWELOPIIIIIENT _
(Indlvl&W propoaw d►eire/opnfen�mustAI-lit.descrl Onbeloworattach 'sit® drawing)
Jq
A%
(-uliderstanc! that a:p�er, dock, mogritig pilitlgs;:fatalcv►►a#er, boathquse, I�ft; ar groin rnust,be set
back a rriinirnum dlstorlcp of i'' from irty, areal. .oT,�#i�>�an.access unless waived by ma, ((# you
wish tb w the se aak, you iriun#'itiiittal thtappto)) bias below.)
do wish #o.waive the 15``sets�ack requirement.
• . �„�, i dq notwish to waive.the 15'setback requirem - - - .
( ` ' t Prope or InforMaton)P ac
PartYwiAdj
Print or T Name
- .-�: .
�lrnAd�►es�
. �rin.,,,J-
Telephone Number-
Date
ctttu' .
or s Ng�rrrrl�,e
umber f _ ;
j
(Revised 61f 62012) = ;