Stanley, John (2)

V.
IL CAMA EJ DREDGE & FILL
AA)L-Fi
�V 67513
GENERAL PERMIT
WjJNe'0
A B /C D
Previous permit #
DModification El 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
Rules attache&
Applicant Name i I
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
city, ZIP
State
Phone # E-Mail
Subdivision
Authorized Agent
City ZIP
0 Cw �w ?�J`IPTA 0 ES El PTS
Phone # (-,J River Basin
Affected
0 OEA 0 HHF E-1 11H El UBA 0 N/A
AEC(s):
Adj. Win Body. 0`(nat /man /unkn)
0 IRMS!,
W: ,.,no PNA yes / Oo
yes 0R
Closest Maj. Win Body
Type of Project/ Activity i�vl. A �
Pier I
Fixec
Float
Finge
Grok
Bulkl
Basin
Boat
Boatl
Beac
Othe
Shore
SAM
Mora
Phot,
Waiv
'dock) length
'Platform
ME
.ng Platform(s)'--,
ir pier(s) U)
i length
number,
loll
iead/ Riprap length
M
No
a
MMMMMMMMMMNMMMMM
avg distance offshore- ­
max distance offshore
*A
,channel
cubicyards
ramp
lip
MENNEN
M
iBulldozing
ONE
MEMORR512
MENEM
M
MMMIMIFM
=MENEM
M
MEMEMOMMMiAMOMMINIMME
MEN
EMMONS
See note on back regarding River Basin rules.
A building permit mayje required by:Note Local Planning risdiction)
".
Notes/ Speqial Con4K
itions ...
a!,5
Agent or-ARplicant Printed Name PermitOfficer's Printed Name
Signature Please read compliance statement on back of permit Signat
)JW
t7l
Application Fc!q(s). Check# Issuing Date l Expiration —ate

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 CarolinaCoastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules ❑ 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 complywith 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.nccoastalmanagement.net/
Revised 08/27/ 14

'Groin I�ngth -••-1
number_
Bulkhead/ Riprap length
avg distance offshore ---
max max distance offshore-1-1
Basin, channel
cubic yards
Boat ramp
Boathouse/ . lift �
Beach Bulldozing
Other i'Y1Cil tZ �1'
■�=
N®1
Shoreline Length % *)w
SAV- not sure yes
MENEM No
'Moratorium: n/a yes JAL
ht
-ph.. ■ ■t .n=w—MMw Iri9 idly__M�1
7r' lei ' t
A
%'
buildingre .
permit may be required b Y
( Note Local Planning Jurisdiction) -
J
❑Seen
to on back regarding Ri r Basin rul
Notes/ S peidal.cop.411tioms
A(L
Agent. icant Pn— N
permitofficer's rin{ed Name
gnature a read compliance statement on back of pormit
siknatdren
Applicatwn Free(s) Check#
Issu[ng D te' . Expiration ato:
— ...,v_.:arti:'JbLv3��iJ&..., _.ti.�aii 5�..�m .`SWay.y,.. .�._.�.:Aia..s.iSa,...,. e.; •..Y.wwnVil...,_iwu_

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: --� .o A -a N ice:.;
Mailing address: Q)'5 w oJ)0 L'y-
1'LjEtc-wS �Dc'r ! N .0 . 2,1 y ©�
Telephone Number: '�5 &' LA at-( d 0G <�
I certify that I have authorized _ DO L,-(agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 0C k T?3pW 4 L t-
at my property located at r7:�) a
Yrl d YZ-E h E to
This certification is valid through
�11 "If 0, .
Signature '
Print or Type Name
Title, co, owner or trustee for property
Date
46u( oo (o S
Telephone Number
(date).
RECEIVED
pL 13 IBIS
W'0�901*
Email Address RECEIVED
JUN 2 l9 2015

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �� o � A � 1� �s
(Name of Property er)
(AaarftS, Lot, Block, Roaa, etc.)
on ',t.M 'Sov h D . in Or-P—he-rad Gj� . N.C.
—(fl♦►aterbody)- (C1WTown, an or County)
The applicant has described- to me, as shown below, the development proposed at the above
Iocati
I have no objection to this proposal
all
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)
p�rQ
1�1�1
WAIVER SECTiO.N
1 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.) V CENEo
1 do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.'
(Property Owner Information)
St afore
PVrint or Type Name
pO6 Woo a1.a0d Ir 1 Vg
Nqg Address
r•Ge. ns 6orwza-
CRYIStaftop
Telephone Number
Print
Infonnation)
RECEIVED
JUN 2 9 2015 y

r 0
ADJ�Ci U lei��1Al11 P i��'ry WHE ffAT9MEM1
I hereby cortifythat I awn property adjacentto � o �A
3 (NaMe of Properbj O%*n
(. do Tess, tot Block� , oa
on ; Savh D _ 1 or�eih�rid
(liVat w body)••. (Cifyli'ovman or•Oou
,s
. N.C,
The applicant has descrtbM. t6 me, as shown below, the dovslopmenf proposed at the above
location . , -
I have no objection to this proposal.
. I have objections to this proposal.
DESCWPTION ANDIOR DRAW NG OF PROPOSED DEVELOPMENT
(Indh4dual proposing d6wfapment must %lllIn deserlpflon below oragach a.wife fta t )
4
�� SIwC'I'ION
I understand that a pier, dock, mooring pilings, braaikwater, boathouse, lift, or groin must be set
back a'minimum distance of IV from my area of riparian access unless walved.by me, .(If you = '
wish to waive the setback, you mum Inttlai the appropriate blank below.) -
I do wish to waive the 16 setback requirement.
I do not wish to waive the 16 setback requirement. !
' RECEIVED �
(Property Owner Information) (Adjacen=ProrMner Informaldonl:L 1015
ha
J ,.iaA.
©tip •s��l�
n 16r Qpxv
INK or Type Name � Prin ,or T j
Ming Address at
! s
Gi lStai�tlp1 Gll'
OYD 2153Y
Telephone Numbw T p�
.45 • V. t
%ete bate
1RevWd MMM RECEIVED
JUN 2 9 2915