Roberts, John & Judy

CAK*A % L D
REDGE & FILL
dENERAL PERMIT Previous permit#
VNew ❑Modification ❑Complete Reissue ❑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 environmental concern pursuant to 15A NCAC
p Rules ;ittached.
Applicant Name �)�`? �.-� '= i Project Location: County t.
Address )�� 1 �� ` 1--1 It 1i { 1 r'`. t i i k 7 J:. Street Address/ State Road/ Lot #(s) ,
City �` 1 State !� ` ZIP< )
Phone # (� )-% r=�4�� E-Mail Subdivision
Authorized Agent . ti . . , -.�.; ! 3 f i City ; ! i ZIP
Affected
❑ CVN i=w �TA ❑ PTS Phone # (, n }i.)"a i •�1- River Basin
❑ OEA ❑ HHF IH ❑ UBA ❑ WA t' ; ; j ( : ; ( !(nat /man /unknl
AEC(s): , _ Adj. Wtr. Body
❑ PWS:
ORW: yes /, no PNA yes /o Closest Maj. Wtr. Body
I
Type of Project/ Activity f,
Pier
Fixe
Float
Finge
Groird
Bul
Basir
Boat
Boat
Beac
Oth(
Shor
SAV
Mor.
Phoi
Wah
(Scale: pyC i I
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length
number
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MEMOMMEME
Emit
A building permit may be required by: ❑ See note on back regardjng River, Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Lt ,
Agent of' pplican Printed Name Permit Officers Printed Name
$Ig tur 'Please read -compliance statement on back of permit` Signature'
)jp ! a - _•=- J'
Application Fee(s) Check# r Issuing Date " Expiration 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 andvoid.
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, certifythatthis 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 (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-41RCOAST
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

r 74t
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: o v� onT3
Mailing address: /3 S
C21%peA7W9
Telephone Number:_ ot►..�t ,2.-�2- '1 S6 •� i�� S� �e�f .i$Z '%� S� 9?D g
I certify that I have authorized ° (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits �v
necessary for the proposed development of Z' Al
at my property located at IY., Zn���„
y
This certification is valid through 20-2 S (date).
(Property Owner Information)
�4-1h-
l/ &��
Signs re
Print or Type Name
Title, co, owner or trustee for property
Date
e-// asz ?/� 970
Telephone Number
�/"AP f90 7iw
Email Aftess
RECEIVED
JUN - 18 2015
RECEIVED
JUN 0 8 2015
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IOCBJ ••• -- ...-w.., u�c WcvvwNiiiGllt NIupuseu at tnd aVoove
1. I have no objection to this proposal.
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(/ndiv,/de l.prQposing de.velppmenf ir►ti t:filf ln: desi r/ption:belo orlaitach.a°site drawing)
WAIVER SECTION
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 initlal the appropriate blank below.) RECEIVED
I do wish to waive the 15' setback requirement.
JUN 0 8 2015
I do not wish to waive the 15' setback requirement -
I
,(Pro. � y Owner Information) (Adjacent Propert pwne rmation)
,, w A / .
Py(nt or Type Name p
M ling Address
City/State/Zip
Zs2- ":� 97d
Telephone Number/email address
Date
'Valid for one calendar year after signature*
Date
RECEIVED
JUN 18 2015
(Revised Aug. 2014)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ����.,-� �;� 16
(Name of Property Owner)
property located at _ /� �/�a�/� f?
c� (Address, Lot, Block, Road, ate,
on S�r6_ _,, in
(Waterbody) `'� ' N.C.
(City o n and/or CoT unty)
The applicant has described to me, as shown below, the development proposed at the above
locatlgr�
ii// I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lnd/vldlJ l.prQposing days�pp rfenf.ma.s. -.irlf:lii:description:beloiivoraitacii'a'sife drawing)
WAIVER SECTION
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 initlal 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)
PAnt or Type Name
M ''fing Address
C���-urri/F1l�c' Z 7�'S8'
City/state2ip
Zsa- 7/?1- 97d
Telephone Number/email address
Date
'Valid for one calendar year after signature`
Date*
RECEIVED
JUN 18 1015
ation)
-naa V;
y Vi0
L/\ f &CEIVED
o JUN 0 8 1015
tMidil au(Jiess
i Zdzar
(Revised Aug. 2014)
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ul
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aRECEIVED
O JUN 0 8 2015
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I hereby certify that I own property adjacent to _IV is
property located at
(Addrasc, Lot gloel , Ro d, a c.
in
Oil (wAerlwdy) (city o n and/or ICounty)
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.
0E6CRIPTION AND/OR DRAWING OF* PROPOSED 0EVEI.OPMENT
(Individual. prop using deWopment must 1011In dascdpt/on below or attach a site drawing)
RECEIVED
WAIVES 6ICTIQN JUN 0 S 1015
1 understand that a pier, dock, mooring pilings, bopt ramp, breakwater, boathouse, lift, orrgrc , ,n
must be set back a minImOrn dlstalnce. of 15' from my area of riparian access unle5 i Walv@d by
me. (If you vyish-fo waive the setback, you* must Initial the appropriate blank beloW.) RECEIVED
I do wish to waive the 15' setback requirement. JUN 18 1015
I do not wish to waive the 15' setback requirement,
(Pro owner information) (Aft t potty Pr.InIf �oflon)�
� ter• ,
Signs o" igrutlur-' ®� jir i /z
P nr or ype Nome Pam, �� Paint or Ty a Name 9d
M angA dress Mailing (N r�,l%
Chyis1af&2ip cityistale+Zip
Telephone Number/email address Telellh s NW sr/ atAddress
Dare • 7
g 'T
00mOA
O Q _ L
'Valid for one calendar year after aignsature' hJ N � (Revised Aug, 2014) •�
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