Stephens, Joseph

CAMA ❑ DREDGE & FILL �J OS�p ' L �� v41
GENERAL PERMIT Previous permit # .
ZI iew ❑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
---27ules attached. `
Applicant Name- ` { ' "�E'" ~' /% Project Location: County
Address t.... fir'" Street Address/ State Road/ Lot #(s)
City , r ` State i� , ZIP .. : / % -: fir' ^ I r
Phone # ( `i c� -,' .:� ) r . E-Mail
Authorized Agent r
Affected ❑ Cw ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: (yes no PNA yes /'no .
Type of Project/ Activity
Pier (dock) length
-Fixed Platforn
Floating Platfc
Finger pier(s)_
Groin length
n ber
ulkhp
avg dista
max dist
Basin, channel
cubic yai
Boat ramp _
Boathouse/ Bi
Beach Bulldog
Other
Subdivision
City % ; , . r ZIP i
Phone # ( ) River Basin "'' v(1, t✓` r
Adj. Wtr. Body ! r ; (!fiat/man /unkn)
Closest Maj. Wtr. Body
(Scale: /' )
Shoreline Length '
SAV: not sure yes nos
r' Moratorium: n/a yes l /
Photos: yes (n¢ '� p
Waiver Attached: yes (Do
A building permit may be required by: , :• n '"" ❑See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction) r
Notes/ Special 'Conditions wi . f` 1� �' a a "1 1' �" r < ✓'
Agent or Applicant Printed Name Permit Of
JA
Signa Pie a read compliance statement on back of permlt•** Signat
ure
Application Feels) Check# Issuin D

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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
0 Tar - Pamlico River Basin Buffer Rules F-1 Other:
0 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] 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)
(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

Agent ortpolicant Printed Name
PermitO
s P 'nted Name
!AA
l.,
�•'r(irE'�^
Orr
Signs PI a read compliance statement on back of perm
Signatur
Application Fees)
C►teck#
Issum Date
piratio Date

Jan 11 16 11:48a
Jan 0916 05:49p
Joe Stevens
Larry G. Arnold La
814-944-6191 p.2
2527263018 p.2
AGEU AWTHO .RATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit:
Mulling address:
Telephone Number: R-j
I eerily that I have authorized � Jai (agent/contractor),
to act on rray behalf; forthe purpose of appi ing and obtaining all CAMA permits
necessary for the proposed development of t2L?
6 �J '
at my prope4 located at
This certification is valid through ,t....� L�(A (date).
(Property Owner Irdormation)
ignature
PAM or Type Name
rt(e, co. owner ortrustee forproperty
Date
To ephone Number
Email Address
,,4x J3Ae,)c Tb Mt
JAN 25 2016
DCM- At
JAN 2 12016
DCM- MHD CITY

1 hereby certify that I own property adjacent to I A's
(PlaMe of Pr9perCy Own r)
property located at
(Address, f, dock, Rodd, etc.)
on �,, in
N.C.
(lillaterbody) (City/Town and/or County)
hrl
as described to me, as shown below, the development proposed at the above
have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development: roust Hit in escrilaV n below or attach a site drawing)
V-pLk
8'd
'
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,iyou must initial the appropriate blank i�lr�iCVE
IV -4_ 1 do wish to waive the 15' si tback requirement. JAN 2 5 2016
C.
IV A I do not wish to waive the 15' setback requirement.
(Property Owner Information)
gn i a e
Print or Tyao Name
ai n A dress
City Statellip
Telephone Number/ email address
*Valid for one calendar year after;signature*
Print or Type Name
_ 4-304-:MUZat(\-be-
Mailing Address
City/State0p
Telephone Number/email address
- _ I _ NA - A610
Date*
R E C L:fJ V C g. 2014)
TY
JAN 21 2016
®CM- MH"

Larry G. ArnoldLa
I hereby certify that I Own propertY adjacent to
property located at 1-6—h / '�Z_
on
Jan 101604;43p
p.3
's
N.C.
. -- - tLieyfrown aridior County)
The applicant has described to me, as shown below, the development proposed at the above
ldc3tlon. � a
l have no abjection to this proposal.
t have ob" lectlons to this proposbl.
DESCRiPT14N ANDIOR DRAbMNG OF PROPOSED DEVELOPMENT
(Individoal pAop05mg developmentt-m�{usi fill in escrlpb n befGw oraitach a side dr vft)
0 ' " �'�,.
in
2627263018
etc.)
WAIN,ERSE_CTION 1
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grorn
must be set back a minimum distance of 15' from my area of ripariar► secesa i�o� I�un
me. {If you wish to waive the setback, you must initial the appropriate blank b CM v E
. ,►, I do wish to waive the 15' setback requirement. JAN 2 5 2016 l
_ I do not wish to waive the L15' setback requirement.
mfRfi
(Prop" Owner Information) CITY
7,0111 Property OWn lintortna "on)
or Type Name '— 1
es�Sa
�s%lc.
d#rd o 0"
pp~ �0 7 Lqo�I Crr Awo J
"Ps 007berl email address 4 [•r.:v�
'Valid for one calendar year after signature'
R'LW E ® l
JAN 21 2016
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00/£0 39Vd 83dSNV81 AII0 0668L889££1 10:01 910Z/£1/10