Sanchez, Denise

V'gADAA / El DI EDGE & FILL
p
o'"E
S�AI�I�- A
;
B C D
ENERAL PERMIT
Previous permit#
r
New ❑Modification ❑Complete Reissue
El Partial Reissue Date previous permit issued
As, authorized by the State of North Carolina, Department of Environment
the
and Natural Resources
and Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Name ,�
❑ Rules a hed.
Applicant A-1-V "' �
--•6 Project Location: County
' Address t- i �} .,, ; �,, w!�
Street Address/ State Road/ Lot #(s)
City �i
State ZIP
-,. 9:, } ,
� � .. i { 1�.£
i
Phone # O,°'t e ! E-Mail " """" "
Subdivision
Authorized Agent ' ~4 t; .•ti a r' 't`"ti`
r , ZIP
} City,
❑ Cw A El ES ❑ PTS
Phone # ~ '' " River Basin
Affected
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
i f
Adj. Wtr. Body`,1.1.'2� 1 } 1',,i ri (nat
Aman/unkn)
❑ PwS•
ORW�es % no PNA yes /j�o� 1
�,�_l
Closest Maj. Wtr. Body `
I
Type of Project/ Activity
ME
M
MEN
MMMMMMMM-
mom
1101111"9011111101
MENOMINEE
MEN
No
■e
�mom
s=
0 See note on back regarding River Basip
,rules.
IN

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 [)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 0 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/ 1-888-4RCOAST
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.nccoastaimanagement.net/
Revised 08/27/ 14

AAMA / ❑ DREDGE & FILL
c
ENERAL PERMIT Previous permit# A B D
ew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
uthorized by the State of North Carolina, Department of Environment and Natural Resources 0�-
the Coastal Resources Commission in an area of environ ental concernpursuant to 15A NCAC�_`r,
❑1Rules attafhed.
hcant Name Project Location: County L :�
re�ss"I Street Address/State Road/ Lot #(s)
StateZIP
ie # ( ) E-Mail = 7"" 7 Subdirvtsion _
iorized Agent j` V� (k City l ' , l t , ' ,` ZIP
aed ❑ CW `EW '*-TA ❑ ES ❑ PTS Phone #`to, 17 0r River Basin 1'
�i-
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A C
�S) Adj. Wtr. Body ,/f 3 0 C. nat . man. unkn
❑ PWS:
V: es� no PNA yes /�0) Closest Maj. Wtr. Body
r. j
ie' of Project/ Activity J` €
! (Scale 1
r (dock) length '" ._X J. _1
ed Platform(s) ' """"' - -- - - -- - - -
ating Platform(s) �' � - � ; --
ger. piers), - !
in length `" " -- - - -AV
- -- -- -- - - -- --
number
khead/ Riprap length — - - - - -- - - - -- - — -
avg distance offshore
max distance offshore
in, channel
eubic yards. ""
at ramp
afhouse/ Boatlift
wh Bulldozing
tier
IC
>reline Length #
not sure yes no
ratorium: n/a yes
�tos: yes no'
uver,Attached: Ces no
iuilding permit may be required by: ❑ See note on back regarding River Basin. ules.
tote Local Planning jurisdiction 1
tes/ S ecial Co ditionsbl­f . .
it"or Applicant Printed Name Permit ffice`r s P i t' (Name'
r ? f
Lture' lease read compliance statement on back of permit Sig tur
!
f 1 '
f
catwaFee(s) heck# (ssuinJD to j' `
g Expirati at

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date �) - '-') ` ) 0 I G
N'''[a�me of Property Owner Applying for Permit:
Mailing Address:
55,-) �e"�►e �r
I certify that I have authorized (agent) J,c. to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) c V- C"k- ,
at (my property located at) 5-53 /JP�VAo-
This certification is valid thru (date) 313 L--61-7
L
3/3 /Lo /-i
Owner Signature/ Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to Le df 5 . -qyic i, 2'Z.. is
(Name of Property Owner)
property located at _L? 5
e- ,�'X-
r (Address, Lot, Block, R/gad, etc.)
on T'; f �C'�il t - �s , in ?' ca :.�`-='.s '. N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to
below, the development proposed at the above
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)
1
N I
I
f
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 initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner
Owner Information)
I en
Si_ nature ignatacre* ,o see,( � j t
Print or T pe Name Print or ype Name
5Sbi f131 l4 bra /f'ewo ®o�
Mailing Address Mailing dress
,e � C�: -��zf- v�� 'S `� `"'!,'c_o r'a-y. 1// �23113
City/State ip City/State/Zip
3 4 - 3761 r a , S Gncke? 'Phj-,.c:. r., tie' Bdy-374- f3'3So? Vs' SO'/- 78.R- ils9
Telephone Number/ 6mafl address Telepho a Number/email address `
��:�
Date Date* J a O / c
7 `
. 2014Revised Aug
)
*Valid for one calendar year after signature* �' v

Mar 2316 02:41 p Graydon Tripp 1-252-756-4422 p.1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at 4
(Address
(Wlaterbody)
MdA
of Property Owner)
Lot, Block, Read, etc.)
own andlor County)
's
N.C.
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
(lndividuat proposing development must rill /n description below or attach a site drawing)
i Yo0t_
' �s v
C� i
I .
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 initial the appropriate blank below.)
—Z?�— I do wish to waive the 1 b' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si azure
Address '
T C�-e�r�tr ��ax5ef
3 3is — % n / — 310-1 / r• o V, e _ s 4-tc-ke
Telephone Number/ 6mail address
3411t.
Date
Property Owner Information)
tf
zCvy.t�r�
Telephone Number/email a ess
Date*
{Revised Aug. 2014)
'Valid for one calendar year after signature`