Richards, Edward

i
L7CAMA /r❑`DREDGE 8c FILL {`, wyv A B D
GENERAL PERMIT Previous permit#
ON ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources / / J /0C—)
and the Coastal Resources Commission in an area gQ environmental concern pursuant to I SA NCAC
-MRules attached.
Applicant Name t. f t 1 j t: t%r! Project Location: County ,�' 1r" {
Address i ` '} •- % r 4/ 1 �'"' C . 1 Street Address/ State Road/ Lot #(s)
CityState tr f; ZIP
Phone # (� {) ' r: ' { ' `� -' 11 E-Mail Subdivision
Authorized Agent City: l' i 6 3 ZIP ► ,� f .
Affected ❑ CW Q EW -❑ PTA .,M ES ❑ PTS
AEC(s): ❑ OEA r❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /.-no} PNA yes snot
Type of Project/ Activity
Pier
Fixe
Float
Fing
Groi
Bul
Basi
Boat
Boat
Beac
Oth
Shor
SAV
Mo
Phot
Phone # ( ) River Basin 011r,
Adj. Wtr. Body '-'�'r'-* t? l � vr" % �(nat'+/mari /unkn)
Closest Maj. Wtr. Body
(Scale /t/--1,
MENOMONEE
ME
F
ME
cubic yards
OMEN
MEMO
MEME
i Bulldozing
NONE
NEEMENNEMENNEMEENEEM
M
loom
MENOMMMUNNE.
MENEMONEEMEMEMN
I
OMEN
MEMEMEMOMMUNNIM
MEN
ME
ON
M-MMEMMEM
EMOMME
Wai
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applli ant Printed Name
_, Y :
Signature r '"Please read compliance statement on back of permit
Application Fee(s) Check # -
❑ Se_e1 not/e� on back regarding River Basin rules.
Permit Officers PrintedJJame
Signature
Issuingbake- f Exphr tion 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 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 consistentwith the North Carolina Coastal 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 1 ) or the
Wilmington Regional Office (910-796-7215) for more information on howto comply with 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.nccoastalmanagement.net/
Revised 08/27/14

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit:
Mailing address: 1 13(c dAA-Po e V t cz L r
Telephone Number:3y
I certify that I have authorized 90,;PVLr-,Y b r-oo r- s (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of W--PCAVCZ Cg C- 5akco*w
at my property located at io i $gc-rZ'y p-_t->
This certification is valid through.
(Property Owner Information)
Signature
Print or Type Name
Title, co. owner or trustee for property
Date
434 -ZG- 490 CF-- t.
Telephone Number
Email Address
(date).
RECEIVED
SEP 16 2015

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
5=, U g-'C'"A.0S
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property, located at
(Address, Lot, Block, Road, etc.)
on , inN.C.
(Waterbody)
Agent's Name #: Be4'' LEA g��5
Agent's phone #:
(City/Town and/or County)
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below.or attach a site drawing)
If you have objections to what is being proposed, you mustnotify the Division of Coastal Management
(DCM) in, wdtfng within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastaimanapement.net(web/cm/staff-listing orby calling 1-8884RCOAST.
No response is considered the same as no objection if you have been noted by Certified Mail.
(Property gw,ner In ormatj
Siglature
u�a►s � GGi�b��
Print or Type Name
Mailing Address
City/State,Gp .
a1A6 nbc(AtCasAQ care eb , dl'K-
Telephone Number/Email Addressc
g -1�
Date f, e - _
(Riparian Property Owner Information)
Signature
Print or Type Name
RECEIVED
Mailing Address
SEP 16 20b
City/State/Zip oKi#
Telephone Number/Email Address
Date
(Revised: Aug. 2014)

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to 6teo P-zL+ r> 5 's
(Name of Property Owner)
property located at Pot
(Address, Lot, Block, Road, etc.)
on 5,- e.wrs Noce P-"-N3 in N.C.
(Waterbody) (CitylTown and/or County)
Agent's Name #: 5&Si� Mailing Address:
Agent's phone #: "ZSZ A-IAD=IL"s 1�,c_A_taz, Nc 2,9531
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
If you have objections to what isbeingproposed, you mustnotifythe Division ofCoastalManagement�
(DCM) in, writing within 90 days of receipt of this notice. Contact information for DCM'offices is
availableathtta:l/www.nccoasfalmanaaementnet(web/cm/staff-listing orbycailing9.888-4RCOAST. Mr&. �Yt4+J
No response is considered the same as no objection if you have been notified by Cerliffled Mail. r-
(Properly Owner)nfo atio
C
Signature
Print or Type Name
.�
ailing Address
Af
City/Stat
!JP
^"573S--
Telephone Number/Email Address
9-
Date
(Riparian Property. Owner Information)
Signature
Print or Type Name
Mailing Address
City/Statelzip
Telephone Number/Email Address
Date
RECEIVED
SEP 16 2015
(Revised: Aug. 2014)