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El CAMA / ❑ DREDGE & FILL r Q
.0 9 A B CD
QGIMERAL PERMIT Previous permit#
bNew* ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by thg State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC i
tE�Rules attached.
Applicant Name 4+Y Project Location: County, r
Address t i' r' Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # (_) E-Mail Subdivision
Authorized Agent
y'
Affected ❑ Cw
❑ EW ,❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / no
PNA yes;/ noj
City.
Phone # ( )
ZIP
' River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
mom ON 00 MEM
ON No 00 00
iiiiii0i
No 0
ME
IN
MIN
M IN
M No
iNEON
ARVIRAYARIPAMMEMME

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 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:
El 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 howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-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

CAMA' J DREDGE & FILL
+ }
GEIIIERAL PERMIT
A B C D
R19New ❑Modification ❑Complete Reissue ❑Partial Reissue
Previous permit#
Date previous permit issued
authorized by the State of North Carolina, Department of Environment and Natural Resources,
/ J f
the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
,f t, ' C
"licant Name `.� t� .� > (: _ 1 ii _
Project Location:
ules attached.
County 9 t sA E
Tress _ { , f I f^,�' - r�,t j
Street Address/ State Road/ Lot #(s) r ' f f
t' 4
1 /
` . f? Stated .i... ZIP
Subdivision _
16rized Agent lVi U 114 �{ U-i,-` `F j r� <<
City
ZIP..
cted ElCW C#"EW A -PTA ElES ❑ PTS \J �
Phone # (
f�
) h River Basin
❑ OEA ❑ HHF El❑ IH ❑ UBA N/A
-(S)
Adj. Wtr. Body
_ (nat [man /unk
1,t ;'
❑ PWS:
N: yes /( c )' PNA yesf�'no
t
Closest Maj. Win Body ;+
$e of Project/ Activity .t, f 1 ,
t
(Scale:
.nfrinr4l IenatF.
..�,
••"" ` I
Platform(s)
N
■I
�aoil
'ng Platform(s)
INN
MIN
No
M
M
0
flength
n umber
IN
w
IN
M
OMEN
IMMIM
ME
ON
No
IMMEME
I
Riprap length
M
No
MIN
NINNEM
i ead/
MEN
1110
Mill
NINE
NINE
,Max distance 9ffspor
MINI
M
uMEMIMME
ONE
MIN
IM
ON
No
min
0
0
EN
INN
IN
cubic yards
ma
i
1
'-iBuildozing
ME
1111112
0
ON
0
E
MMMM1MMM
summmmmummoommi
ON
I
No
NOMMM
ME
MWE
0
0
MENME
M
MIM
MIN
MINE
ME
MENOMMENEENOMON
MNIMMMMM
yesk
SOMEONE
No
MEN
0
Juilding permit may be required by: ri �; t ,' ,' '(% ❑ See note on back regarding River Basin rules.
Tote Local Planning Jurisdiction),,,!, / E
tes/ S ecial Conditions t o - I i I j ( i ( <<
{ f fit... _ F i f
p 4
f•. ;��
od
oc:4pplicant Printed Name Permit Officer s Printed,Namer 1 �P�
1^r y .r
:Ur 'e Pleassey_ead compliance statement on back of F
anon Fees)
Signature
IssuinDate/ j Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:_ _
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized 0.2 ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 17�`�" =&A- 2
at my property located at._�
MAY 2 0 20
in County. TY
I furthermore certifythat I am authorized to rant, and do in fact r " CI
g gi�rmission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
J 0 S"-ntf r �0-�
Print or Type Name
Title
4 / S / t. (.-,
Date
This certification is valid through
RECEVEC
MAX 19 ?016
DCM- MHD CITY
°DC*
RECEIVED
MAY 262016
®CM- MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
1©, r'
Property Owner)
's
(Addrgss, Lot, Black R ad, etc.)
on , in F f , 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)
S �
E-�, -'4 '1 �J 5 '-) cb -,a t i
�13.33
Gu `A25
DECEIVE®
WAIVER SECTION MAY 2 0 2016
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boa tJ' r i
must be set back a minimum distance of 15' from my area of riparian access unless wt�tlTY
me. (if you wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 16 setback requirement. RECEIVED
1 do not wish to waive the 15' setback requirement. MAY 2 6 2016
(Property Owner Information) (Adjacent Property Owner Info )
��'' nn Ei ®CITY
Si ature Signature*
Prints for Tvpe Name 1 {� Priint or Type Name i
Mailing Address M f ing Address
Cit)r/Siahv2ip City/StataOp
Telept�pne Number/email address Te pho a Number/email address
s_ c6
Date Dat
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to
property located at I CD
Owner)
)s
on (.� ,Y (Addrelss, Lot, BI Ro d, etc.)
in N.C.
(Wady) (Cityl own andlor 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)
-A 3 = 11'�� : 2-7 y 3,33
RECEIv
a X
I p s c� I
MAY 2 p 2016
DCM- MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or gran
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.)
1 do wish to waive the 15' setback requirement. RECEIVED
I do not wish to waive the 15' setback requirement. MAY 2 6 2016
(Property Owner Intonation) (Adiacent Property owner l,22,z 2 ►:; ao n
Sigl�ria we �^
id "C 3E 3GrY ve"
Print or !�pe' Name �_
ailing Address _ {
P _
Telephone Number/emar7address _
`-I, tZ , le
Telephone Number/email address
Ct— �— Z
Date's
*Valid for one calendar year after signature* (Revised Aug. 2094)