Sullivan, Gary

AZ
04"AMA El DREDG E & FILL C
14`066878 '
0 AB D
GENERAL PERMIT Previous permit #
DNew ElModification ElComplete Reissue EJ 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
'R Ryles attach
Applicant Project Location: County
Address J,�,-J C,� Street Address/ St4te Road/ Lot W(s)
/7
�-A ZIP,' A
Sitatedry'� City-11L
Phone #
Oa) Mail- ------ . I Subdivision
1. t1-11f XA
Authorized Agent cityZIP —
Affected
El TA El ES 0 PTS Phone # Y"�River Basin
0 OEA 0 HHF 0 UBA [I N/A
AEC(s): Adj. Wtr. Body(nat /man /unkn)
o PWS:
Closest Maj. Wtr. Bodyell ,
ORW: �6s,�/ no PNA yes /('n" o C,
Type of Project/ Activity
(Scale:
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)—'
Finger pier(s)
. ... .. .. ... . .... ... . . . . .... ... .. .. ....... .... .. .. .. ........ ........... ........... . ..... .. ..........
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
4L
max distance offshore
Basin, channel
. . .. ....... .. . . ... ........ . ........ ... ..... .. .. ... ... ... ........... .1 ........... ....... ... T . .. .... . .. .... ..... ..... . ... . ...... ...... ... ....... ... ........... .. ... ..... .. .... .....
cubic yards
Boat ramp — —`
Boathouse/ Boatlift
Beach Bulldozing
Other,-./ k- V --Irk
Shoreline Length
lyl/�l Jul) �Ulu
SAV: not sure yes no
�c ILA f1tr-- fl
Moratorium: n/a yes 1�0,
i
Photos: yes noWaiver
r
.. ... . .... ........
... . ...... ...... .. ...... . . ........ . .. .... . ... .......... ............ ...... .. ..... ....... .. . .......... ...... . ....
Attached: yes no
-7
1A 1
A building permit may be required by:
•El
See note on back regarding River Basin rules.
Note Local Planning Jurisdiction
r II,4
Special Conditions Notes/
IN, 1
4.,Agent"or Apf�Eant rinted Name
Permit ny f4am
er s
41
71c
ig6atpre, �Wse read compliance statement on back of permit
Signatde
ADDlication Fee6)
Check # .
Issuing Date
xpiration Date
J.,

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:
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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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 / ❑ DREDGE & PILL
GENERAL
A g ��p
�Previous
PERMIT
permt
ONevv ❑Modification ❑Complete Reissue
❑Partial Reissue
Date previous per 't issue
ithorized by the State of North Carolina, Department of Environment and Natural Resources
the Coastal Resources Commission�in an area of environmental concern pursuant to 15A NCAC
t t
leant Name i #'
Project Location:'
r Rules attac
County ;
`ss'
SteefIddess/ State Road/Lot #(s)
a 't'f�'
.1 State
ZIP:
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Subdivisi n
\
iorited Agent d r 1.,
'!_ City i '
' ZIP
❑ CW W�TA ❑ES ❑ PTS
Phone #;ted
- / fiver Basin❑OEA
❑ HHFH ❑ USA ❑N/A
�s) ,
Ad'. Wtr. Bod
1 Y�,'�
'� nat .man `unkn
❑ PWS elN
/ no PNA yes
(i f
Closest Maj. tr. Bod
e of Project/ Activity
%
3tos: yes ( s
i
Liver Attached: yes o E
.j -,%
>u, ilding permit may be requ ed by: - , t
❑See n to on back
regarding River Basin rules.
dote Local Planning)urisdictin r
1
1 t
tes/ Sp cial Conditions'
f
✓.
o ' t, rinted Name
Permk O is
's Pr' + ame
l p
3
it014se read compliance statement on back of permit
Signatu "l'~
cation Feels} Check
piration ' ate
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2sMay, 3. 2016 8; 57Untrois
r�
08: 1036 P.m.N 0, 1419-20, P. 2 1,2
MA GIT ON N PROPERTY (AMS -R $STATEMENT
I hereby certi'p that I own pabperty adjacent to .J � � /!� .� _ s
e of mP Owner)
praldeRY kxasd d "�.7�' �.y�_ Q19Z 1, _dC„�,:.�...�..,..
(A�idress, Lot, Block, Ro1id, etc.)
on In a N.C.
4�erbod (C own andlor County)
Thai applicant has iteswbed to me, as shown below, tie deveiopmW proposed at the aba% a
lOCex
I have no ob,edion to thi; proposal.
I Dave *s0ions to this Iwoposel,
10 CRIPTION ANDIOR DRAWING OF Pkoip SEED Dte1/l:I.04MENT
phc(Aidua)f roltu ft development must M1 in desci 1p9on below or aftch s she drawfiil j
RECEIVE®
MAY 0 6 2016
®CM- MH® CITY
yY = BE0(LN
I unlderstand th;I a pW, dock, mooring pilings, breakw iter, boat we, lift. or groin must be 4 :t
back a minir wm distance ,3f 15' from my arm of riparian access unless waived by me, (If It u
wisA to wain i th s 93tbadc, ,rou must Int ial the approp(ate blank bekwv.)
I d-) wish to waive Ift 15' Setback mquirenernt i
I d o not wish to waive the 1 S setback mq Arement. }�
(Pr petty O nner Infamyion) (Adjacent Property Owner
Dare
o c do ph
A610h�A.do,
CA
614J . O fro
TeAgpho�e Number
Dwe
(Revised W aQ01. j
Z 'd SIC1ON Wdlj:tl 91ai'1 'AIN

zsMay, 3. 2016 8; 57Wntrois 08:10:48p.m,No, 1419-2011P, 1
2;2
a5-Z^3s3- 9002, f-,4 -A,
AGENT AUTMORIZAT ON EORM FOR -PERMIT APPLICATIQNS
Name of Property Owner Applying for Permit.
Mailing address: se��
Telephone Number:
I ceriffy that I have authorized ' s o (agent/contractor),
C
to act on my behalf, for the purpose of applying and obtaining all AMA permits
necessary for the proposed development of �ri l ��&�r�►e�►
at my property located at
This certification is valid through �d/_�,,vf za-za/c (date).
(Property Owner InformatiQQ)
�Siign�ature
Aft or Type Name
Title, ocf. owner rtrusteeforprope
Date
1' 3 S- "aD
Telephone Number
Email Address
RECEIVED
MAY 0 6 2016
DCM— MHD CITY
1 'd 91.01 'ON 14011 91011 'A'A