Ryan, Patrick

qCAMA DREDGE & FILL
GENERAL PERMIT
Previous permit #
fl4slew ElModification El Complete Reissue
El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
V(
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
U Rules attached.,
Applicant Name
Project Location: County_:..
Address
Street Address/ State Road/ Lot #(s)
City � zip
?tate
Phonefl 11) :/FaD4,`(­
Subdivision
Authorized Agent
city�l P —
El CW El EW PTA [:1 ES El PTS
Phone # (2L�) t4b4ver Basin 1, 11 t
A(
Affected
AEC(s): El OEA E IH E-1 UIBA 0 N/A
Adj. Wtr. Body :,"kf;"3 . It' �(nat /man /unkn)
El Pws: El FC:
... Y,
ORW: yes no PNA yes no Crit.Hab.
Closest Maj. Wtr. Body
yes no
,
Type of Project/ Activity
(Scale:
Pier (dock)
Platform(s)
Finger pier(s)
Groin length
—7
17
1
number
Riprap
Bulkhead/ length
Ll
—T1
d
A -
1
avg distance offshore —
t
W.
max distance offshore/
Basin, channel
cubic yards
---
----
. ..
....... .
Boat ramp
Boathouse/ Boatlift
RPMV�ID
Beach Bulldozing
ArK
I
Other
Shoreline Length
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
"J,
Photos: yes no
Waiver Attached: yes no
A building permit may be reqyirVd
El See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please 'read compliance statement on back of per omit
Application Fee(s) Check#
Permit Officer's Signature tL
Issuing Date , Expiration Date
Local Planningju'risdiction 7 Rover File Name

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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar- Pamlico River Basin Buffer Rules
❑ 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 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 Morehead City Headquarters.
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-8884RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

N.C. DIVISION. OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date Lr— I — Ir
Name of Property Owner Applying for Permit:
f�i�01rI�17,/C rC a. n.n6
Mailing Address:
3 �o3 ZIr{
t,.�i(S.iy N •c• 2 i�9G
I certify that I have authorized (agent) Al c-c wegd� 1IQ...-t-- to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) L rj 5 fz // Alatfoow 49)
at (my property located at) 20 o 1911-P
Li
REC�IVEO
p,QR � p 1�1ti
This certification is valid thru (date) /0—/6-"
Property Owner Signature
7—/ —/s— RECEIVED
. RECEIVED
APR 2 7 2015
Date APR 2 7 2mi

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
J
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM Name of individual applying for the permit:_ AW14=X K/�modd
Address of property: aO46
(Lot or street#, street of road)
Mailing address: 3.W.3 f , E
l
(City & County)
Phone number you can be reached at
I hereby certify the I own property adjacent to the above referenced property. The
Individual applying for this permit has described to me (as shown on the attached drawing)
the development they are proposing. A description or drawing., with dimensions, should be
provided whit this letter.
�fihaveno objections to this proposal
If you have. objections to what is being proposed, please write the Division of Coastal n�CENE�
Management, 400 Commerce Ave., Morehead City, NC 28557 or call [phone] within�eR 2 0 1015
10 days of receipt of the notice. No response is considered the same as no objection if you FAN
have been notified by Certified Mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or sandbags
must beset back a minimum distance of 15' From my area of riprap 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
�do not wish to waive the 15" setback requirements
Signatur Date
Print Name
Telephone number with area code
RECERVEn .
APR.? 7 .:,.„

m
n
<
H m
o O
cr
"4'jF
v 5�+

•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to ALA-r•r'k I is
(Name of Property Owner)
pr
a
9 ertv..lo4atec�._ t.06 _ u+,ev?
on l v%we •Hal in
(Waterbody)
(City/Town and/or County)
The appllcao has described to me, as shown below, the development proposed at the above
locatio
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)
0 0
4
is o-i- o
+o a se.Q G•; �� ` oioc,tc exSteNSim'Y
01p15
PQ� �
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.)
RECEIVED
/ I do wish to waive the 15' setback requirement. APR 2, 7 2niS
1/ I do not wish to waive the 15' setback requirement.
(Property Owner Information) �A1djace,�t1Property Owner information)
/a f- # Y "M
Print or Type Name
Mailing Address
4r lsor► 1A 27876
City/State/Zip
252-.23S- -77 41
Telephone Number
) - Y-- Ir -
Date
YJ "Y-`(, V^o) YXI <
rint or e Nam
101
Mail y.Addre s l�
1 L.. QtJ
ify/Stafe/Zi�
Tele ho � u ber '
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