Read, Fred

NCAMA / ❑ DREDGE & FILL IN
GENERAL PERMIT( ) Previous permit#
New ❑Modification ❑Complete Reissu al Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources rN
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
ules attached.
Oplicant Name Project Location: County
ddress I� c -' f/'t =',~x i VA � Street Address/ State Road/ Lot #(s)
City �"� r i.y- f `/V?i(�State /
Phone # ( f 1(r't •, Fax # (—{)�
Authorized Agent l�t j { j" i :r' r {.
Affected ❑ Cw r EW _1� PTA ❑ ES ❑ PTS
AEC(s): ElOEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FQ
ORW: yes / no ' PNA yes /o,? Crit.Hab. yes / I of
r � (.
Fe Project,/ Activity 4% i t , { cJ�'`C'-;
Pier
Platt
Fing
Groff
Bulk
Basi
Boat
Boat
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Phot
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Subdivision
City / ZIP
Phone # ( ) River Basin
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A building permit may be required y: ^`t"",G~� '- _ \ Sir"1 . F% ❑ See note n back regardin River Basin rules.
Notes/ Special Conditions �� ��� � �

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, certifythatthis project is consistentwith the North CarolinaCoastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules ❑ Other:
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/ 1-8884RCOAST
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

DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date "1 • t 2 • / S
Name of Property Owner Applying for Permit:
Mailing Address:
1*-)o On L lc -a g- Vr wo'
?1:S ij.e-,-.
I certify that I have authorized (agent) m U-D ` —e- kiTVre,45 )L;S to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) ::Z kj S 4-0- L( L L 44
at (my property located at)
This certification is valid thru (date)
Property Owner Signature
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to i rLlz.n Z�-o-o 's
(Name of Property Owner)
property located at � % � � �-kL`e-r'.� 'D�� ��"
(Address, Lot, Block, Road, etc.)
on "S�� `��►.-y , in `PkS , N.C.
(Waterbody) (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 fill in description below or attach a site drawing)
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 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
J?
Signature Sigmature
Print or Type Name Print or Ty a Name
-) © b;'kLm -� - o/-
Mailing AddressC Mailing AddressQ Ar C D q
City/State/Zip City/State/Zip (0 ✓
Iz .5 -Z_ Cz Z- -. gz(0g
Telephone Number Telephone Number
`l . i 3. ) 5 q19- 79-7-07
Date Date
(Revised 6/1WO12)

ADJACENT RIPARIAN'PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Ff�.n '?-JzQ-U 's
(Name of Property Owner)
property located at )� g � 4 IJC' i vZ;
(Address, Lot Block Road, etc.)
on �oS �� �jo v..-� in � 3 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
Gw I 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)
<11
WAIVER SECTION
I 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Eat- 1) t2;E-)eD
Si ature
Print or Type Name ,
J1c) o 1)��-p,4 v,6-
Maili Address 2 "a S 1Z.
City/State/Lip
Z-5Z (.22. 42G17
Telephone Number
Date
(Adjacent Property Owner Information)
Sign tune
Print or Type Name
Mailing �Iddress 74XAC,4AT-S'—
CitylStaterZip I
q1Q q U
Telephone Numb r
Date
(Revised 6118, 2012)

P C Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Read
Date: 8/8/13
General Permit #: 62726C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
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169
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Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ . Fill ❑ Both ❑ Other ❑
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252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10