Snow, Janice

CAMA / DREDGE & FILL SA)O
GENERAL PERMIT
Previous permit #
-"New 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 I SA NCAC
_i Rules attached.
Applicant Name
Project Location: County_
Address
Street Address/ State Road/ Lot #(s)
--------,-State --- ZIP
Phone # Fax #
Subdivision -`'
Authorized Agent -
City ZIP------
CW SEW [ PTA ❑ES ❑PTS
Affected
Phone # ()------------- River Basin
- -- - - - - -- - _
__
OEA ❑ HHF ElIH [I USA ❑ N/A
AEC(s):
(nat /man /unn
Adj. Wtr. Body_- —-----_--_--- --- k)
PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body -- --- -- - - --- -
Type of Project/ Activity !
Pier (dock) length
Platform(s)_
Finger pier(s)
Groin length----
number---
Bulkhead/ Riprap length
................
avg distance offshore
max distance offshore
Basin, channel
cubic yards ----_._..
Boat ramp _
Boathouse/ Boatlift
Beach Bulldozing
Other A 1. 0
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
i..
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
li--N�'
(Scale: :, --� .ov
RECEIV
—y 0
❑ See note on back regarding River Basin rules.
d C.lJ ' .t
-- i i j
Agent or Applicant Printed Name Permit Officer's Signature
)I
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Issuing Date Expiration Date
Local Planning jurisdiction Rover File Name

9
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
❑ 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 howto complywith 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

Nov. 3. 2014 4:48PM No.4215 P. 2
^" n rAKIAN p
lhereh ce ' property T T p T
y rhfy that I ovenadjacent to tA-+,t zv_ f T.
ProPany located at 's
. C .L' 1, e, 40. , � � � � Name of Property Own@r)
on(Addn, Let, BIpc11, Road etc.)
(VYatetbady) n "e /t xr C'AQ r 7� N.C.
(CltylTown and/or Caunty)
The applica
Ihas described to me, as shown below, the development proposed at the'above
loca#on, ve
I have no objection to this proposal.
—.i.� I have ob)ections. to this proposal.
DESCRIPTION AND/OR DRAIMNG OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description below or attach a site drawing)
RECEIVED
Nnv 0 5 2014
DCM-MHD CITE'
I understand that a ier, dock, moorin v — %ji `N p g pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of.15 from my area of riparian da*g$ Unless waived by me, ([f you
wish -to Waive the setback, you must Initial the, appr,oPriate blank below.)
——. I do wish to waive the 15' setback requirement.
. I do not wish to waive the 15- setback requirement.
(property Owner-Informadon)
(Adjacent Proparty Owner Information)
s �
�/lar�
Print or Type Name
'� I-
'5-t-u'
r �?
iUlallirl Address — -- �--
P nt or TYRE Name
MattgAdd
lY te/Zip
Telsph N
ne ber
Telephone NUM r
Date
Dats .,
(ROVlsed 6/1a/2012)

Nov. 3, 2014 4:48PM
I
No. 4215 P. 3
..� WAINWAIC8 t1tALV P O it
T r
1 hereby certify that I own property adjacent to
ANt IC ofproperty located at �--t v (Name o Property
�'
L° 1. � f Owner)
0� (Add rl g, Lo Block, Road, etc.)
Waterbody) in �'
(Citylrown and/or County) c• �,� N.C.
loc applicant has described to me, as shown below, the development proposed at the above
locatlgrt,
�,_ I have no objection to this proposal.
I have objectiong to thls proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till In descdptyon below or affach a site drawing)
-SX-L4'• ---
RECEIVED
Nnv 05 2014
DCM-MHD CITY
t understand that a plat, look, mooring plltngs, breakwater, boathouse, lift, or groin must be sot
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.
-- _ I do not wish to waive the 1 & setback requirement.
(Property Owner -information) (Adjacept Property OwnerAnf, maIf P P, , .: -, 5 - /
}
tore 3t ` _ � •
Aa..►1c� �Ivn .. !1�ts1 �• �`�.M1� LiJZ•
Print or 7j pa Name Pdat or T IV,
Mallfhg Address Maul g Address
C1111/staft0p Gl�Imstst
l- GP - r? 7��`761�'
Telephone Number Telspha Nu er
2 l�
Date
(Revised &1&2012)

Nov. 3. 2014 4:48PM No.4215 P. 1
f,Ari
NCDENR.
North Carolina Department of Environment and Natural Resources
Dlviston of Coastal Management
Michael E. Easley, Governor .fames H. Gregson, Director William G. Ross Jr., Secretary
Date
Applicant Name A
Mailing Address 2-2- 1 CL-v (3 el lX
CAr & -r tJC -;,/I
I certify that I have authorized (agent) o to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
This certification is valid thru (date)
Signature
RECEIVED
Nnv 0 5 2014
DCM-MHD CITY
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer— 50°A Recycled l Iffa Past Consumer Paper