Pridgen, R. Wayne

F�,­ 0.,
V
CAMA DREDGE & FILL
66938
A B'
GENERAL PERMIT Previous permit #
QTINew DModification ElComplete Reissue ElPartial Reissue Datprevious 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 pursya'nt to I SA NCAC
aules`ittached.-.'
A
Applicant Name (,,�?Y'Olect Location: County_
Address Street Address/ State Road/ Lot #(s)
City State -ZIP
Phone #
E-Mail Subdivision
-J
Authorized Agent City zip
PTA ver Basin.
Affected 0 Cw 0 PTS Phone
' S El OEA El AHF 0 lH tBA El N/A
i(/n /)
AEC(s): Adj. Wtr. Bodynat maunkn
❑ PVVS;�7-
ORW: yes/ no PNA yes Closest Maj. Wtr. Body —
To
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) --
Groin length
,.,number
,Bulkheid/,Rjprap length
a v g distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no. -
Photos: yes Igo
Waiver Attached: yes no
A building permit may be required by:
Note Local Planning jurisdiction)-\
Notes/ SpIcial Conditions
6�mt 7r Applicant Printed Name
Signature,, t* P)daseyqid compliance statement on back of permit"
plicatlon�6e(s) Check#
(scale:
El See note on back regarding River Basin rules.
I
1 ? i s, 1k i , I..
Signature
ing Date', Expiration ef

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
0 Neuse River Basin Buffer Rules
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 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/ I-888-4RCOAST
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.nccoastalmanagement. net/
Revised 08/27/14

'4PAMA & FILL
J
GENERAL PERMIT Previous permit
'E!New ElModification 0 Complete Reissue 0 Partial Reissue Date previouj 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 pursyant to I SA NCAC
-0.Rules attached
.J
Applicant Name �-1 J, 1 11 Prdr6ct Location: County
Address
Street Address/ State Road/ Lot #(S)
City
State Zip Y, i
Phone # E-Mail Subdivision
Authorized Agent .'4 7y
2 City
0 Cw n-EW ),PTA Phone#
Affected �s D PTS
11 OEA 11 � HF 01H 0 USA El N/A
AEC(s). ❑ Pws. Adj. Wtr. Body
Cl
ORW: yes/ ho, PNA yes Closest Mal. Win Body
T!,
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
b ,Tmm, er
Y
�Bulkhead/,Riprap length 's
avg - distance offshore"
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatliff
Beach Bulldozing'
Other
Shoreline Length
SAV- not sure
yes no
Moratorium: n/a
yes 1 00,"
Photos:
yes no
Waiver Attached:
yes no
ZIP
(Scale: —7. - A
N
0
N
ON
N
N
ME
E
N
ONE
N
No.
I
IN-ILI
all
ONE
N
E
MEN
ON
0
E
0
M
E
MEN
NOON.
A building permit may be required by:
Note Local Planning Jurisdiction)'N
Notes/ Spe.Fial Conditions
Apht
Y
licant Printed IN
See notF on back regarding River Basin rules.
ure F' ease read dbmpliance statement on back of permit Signature
J,
4
atfbn'Fde(S) Check# lssuihjDat6
Expiration Dade

r
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 2 - IO - l 4
RECEIVED
Name of Property Owner Applying for Permit:
n FEB 17 2016
�
DCM- MHD CITY
Mailing Address:
I certify that I have authorized (agent) %u c Ujohe "oZA--. to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) i4s,46,e 3-4- 6wf o1-&st ft ,6-114,-1
at (my property located at) 2v3 kH6-P R A t A 40y 11-f/arofL- A,A- /.f C.
This certification is valid thru (date) ! a 3 �RECEIVED— L
FEB 2 4 2016
Property Owner Signature
DCM- MHD CITY
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /x . �� xdz PJi-'1 d':4 eis! 's
2#1
ame of Property ner)
property located at 1 Q-3 ®o.u� .
(Addres , Lot, Block, Road, etc.)
on k,r , in 44a m 7—, e Jae a e I , N.C.
(Water (City/Town and/or County)
The applicant has described to me, as shown below, the developmer aPA1)h FMQbove
location.
✓ I have no objection to this proposal. FEB 17 2016
I have objections to this proposal. DC M _ M H D CITY
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
RECEIVED
FEB 2 4 2016
WAIVER SECTION DC M- M H D CITY
I understand that a pier, dock, mooring pilings, boat ramp, 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.
I do not wish to waive the 15' setback requirement.
T / hone Number/email address
Da
(Adjacent Property Owner Information)
Signature * L
fsx'e
Print or Type Name
ZS31 J «.x
Mailing Address N.G. Z •ijr"1�Q
City/State/Zip
'tiq -` )g - i'tigy
Telephone Number / email address
-- Q.."z©, a© /h
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

I hereby certify that I own property adjacent to 's
r,tNtflme of Prope Owner)
property located at ''
(Addr s, Lot, Block, Road, etc.)
on , inTL�'1-7 efAC'J-� , N.C.
( terbody) (City/Town 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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
DECEIVE®
FEB 17 2016
DCM- MHD CITY
WAIVER SECTION FEB 2 4 2016
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access urJD0 f \JWRD CITY
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.
(Property Owner Information)
�e
Sig ture
(A acent P p Owner formation)
Sig ature
Print or Ty a Name ,�l
qr �b ra MT �44 (4 .
Ming Address 7s
City/State2i
e, I Zi,7_- lIV 6w
Te1e ' hone Number / email address
Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature*