Seaside Siblings

2 �Cg?
L'CAMA / DREDGE & FILL
GENERAL PERMIT
Previous permit #
FNew -'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
❑ Rules attached.
Applicant Name
Project Location:
County
Address r'
Street Address/ State
Road/ Lot #(s)_
City -- - State ` ZIP;.
Phone # (-_)_ Fax # (i_)
Subdivision- -
-
Authorized Agent --
-- City
------- - ZIP -"
CW uEW 0-PTA ❑ a ES PTS
Affected
Phone # (-- -)
-- _ - --- -River Basin
AEC(s): rl OEA HHF ❑ IH ❑ UBA -] N/A
Adj. Wtr. Body
— _ — gnat /man /unkn)
PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab.
yes / no Closest Maj. Wtr.
Body —
Type of Project/ Activity i 1i e /-� X f
Pier (dock) length
Platform(s)_
Finger pier(s)
Groin length -- — —
number
Bulkhead/ Riprap length
avg distance offshore --
max distance offshore
Basin, channel
cubic yards r
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other --
Shoreline Length
_
SAV: not sure
yes
no
Sandbags: not sure
yes
no
Moratorium: n/a
yes
no
Photos:
yes
no
Waiver Attached:
yes
no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Pn6t d Name
Fm
V
(Scale:
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Issuin Expiration Date
Lo �gj.ris6cwn Rover File Name

0
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, certifythatthis project is consistentwith 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 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 howto comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

A=4j
®
DENR
North Carolina Department of Environment and Natural Resources
Division of Coastal. Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director . Secretary
Date 2 G� `7l
Applicant Name � ea s
Mailing Address iJ D 4 5 q
EwraAct L*[-e q
I certify that I have authorized (agent) /', ! to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
rM`/ -1 g D 4 �t' at (location)
_5iCA ZA- Vel? 'err 4(111 iq,'rS i le
_ This certification is valid thru (date)
I
Signature
400 Commerce Ave., Morehead City, NC 28557 One
Phone: [phone] FAX: [phone] Intemet: www.nccoastalmanagement.net NOI't�1fCAto/aa
An Equal OpportunitylAffirmaliveActon Employer

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to 5P_ s J-Q is `I S 's
r(NiTe of roperty�wne f�� ��•,
property located at -I sue" '� �''�'�✓`�
(Address, Lot, Block, Roa , tc.)
on S.� "-� , in i -era C N.C.
(Waterbody) (City/Town and/or County)
The applic nt s described to me, as shown below, the development proposed at the above
I ti
eve no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing developmen must fill in description below or attach a site drawing)
,
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 bank below.)
do wish to waive the 15' setback requirement.
!y/ a _ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
�S
�cCf�
Pript0 Type
Mailing Address
r��rA (d�f, n�� a�s�l�%
%§tategip
Z-Ctc-t0.5/0Z
Telephone Number
Date
Property/Oyiner Informati
(Revised 6/18)2012)
vised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to 5P_, 5 td'� �� h `, 5 's
(N� a of Prope wner)
property located at -I s'L"er��^`�'�° ✓`aldl-Sr G��
(Address, Lot, Block, Roa , tc.)
on w S,a -��( , in 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 40 this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing developmen must fill in description below or attach a site drawing)
CX3 le
L
WAIVER SECTION
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 bank below.)
ryfv� do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent P operty O n nformation)
S Signa%e
� Print or Type Name
PP-1
o0 K Ty Namr�1 i 0 c-&
Mailing Address
Mailing Address lavw\tn'u '4-0" hC ZJ� S'y'¢
�161 (�(� . AIL a$�l�% City/ Late ip
9'yst teZip 7(ZZ �2 s3 � - 3 3 34
Telephone Number Telephone Number
�lp., ILf 2ci4
Date
Date
(Revised 611812012) 1 (Revised 6/18/2012)