Tetterton, Hilton

W
04 !!!
UTCAMA El DREDGE & FILL
TRO, 67760 A B C D
PENERAL PERMIT Previous permit #
EINew ElModification ElComplete Reissue El Partial Reissue Date previous.permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources �ofnmission in an, area of environmental concern pursuant to I SA NCAC
[�*leS attacheq,,'
Applicant Na" Project Location: County
Address—,. 13 kA Street Address/ StnRjad/ Lot #(S)
9tat City e ZIP
Phone # EE-Mail
Authorized Agent
Affected OCW OEW ffM �0 ES El PTS
AEC(s): El OEA El HHF El 1H F-1 UBA 0 N/A
1:1 PWS:
ORW: yes / .no ,. PNA yes/
Q?
1 7
city ZIP
ver BaselyPhone #
Adj. Wtr. Body
i (nat /man /unkn)
Closest Maj. Wtr. Body
M.
MENEM
L=
Mill 11 '311111 111 Offill
ar m
Ageq.orApplicafni PrintedrName f !, Perrnitofql*is Printed Na
Sign Signature Please read compliance statement on back of permitatur
Application Fee(s) Check # Issuing Oate Expiration Date

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 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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

1�

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
w
Name of Property Owner Requesting Permit: kcw T-f-- 47e,- rJol
Mailing Address:
Phone Number:
Email Address:
certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:U`
-cam Vv-A 'vj-
at my property located at
in C �'.r"�c� County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Print or Type Name
� RECEIVE®
itle
AUG 092016
1—I —'22'1
1� lVIHD CITY
Date DCWI®
This certification is valid through I l

14
000- L-o <a- A � Let c.. 9 cn� .5
c
W--
EIl1ED
p 9 nis
vs

ADJACENT RIPARIAN PROPERTY OWNER SiATEM T
I hereby certify that I Own Property adjacent to C'_%` S
P.
(Na a of Pr rt. Owner
propert located at
(Address, iot, Mock, oad, et
on 4 C✓'. , inr�.. , N.C.
(Waterbody) (CityiFown and/or County)
The applica as described to me,. as shown below, 'the. development proposed at the above.
ca 'on.
G� .l' have no objection to•this proposal.
I have objections Ito this proposal.._ j
DESCR(PTION.ANDIOR L?R�1VIfING OF'ROPOSED DEVELCPMfENT..
(Indiyidua! proposing development nrusi fill `in ctescri ' on bolo attach asite drawing}
WAIVER SEOTION : T
i understand' that: a pier, dock, rrroormg pilings, breakwater, boathouse; lift, or groin must be set
back a minimum distance of 15�' from my:area of riparian access unless waived bye
wish to waive.the setb ck, you must initial thd. appropriate, blank below.), 9'i �� OV E ®. '
' I d ..'sh. to waive the 15' Setback requirement. AUG 09 2016
_, J_
I do riot wish to waive the 15'setba6k requirement.. ,
DCkA
HD CITY .
(Property Owner Information) (Adjacent Property Owner Information)
i natur
g ig :.afore .
n
Print•or ype ame rin :or T�e N
IMaft;,ydres
.l
dress
r Z
. a
CffYlStat l CrtylS -
�.
Tele hone Nc{m or re, o o4 e Number y
Date Date
(Revised 6/18/2M) .

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to _ 1 i ! 3� A✓
property located at 5-0 6
e of Property Owner)
r
C4Ca.C,r<- w q (,
(A ress, Lot, Block, Road, etc.)
on C U � 5�4�- I,f < i` , N.C.
in �
( aterbody) ( / % (City/Town and/or County)
Agent's Name #: 1-'al" ` �" Mailing Address: G , C
Agent's phone #: 0-
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing developm nt must fill in descri13tion below of ettach a site drawing)
S�r� `�.,� la- ^G
L` RECEIVE®
AUG 0 9 2016
If you have objections to what is being proposed, you must notify the Division of Coast n e ®' �T
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp.11www.nccoastalmanapement.net(web/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information
Signature
LL-
Print or Type Name
(0,�-A00/\—
Mailing Addres l�
City/State/Zi
Telephone Number/Email Address
� )--//L
Date
�parrip Pro�ert Owner Information)
AIA
ignatur
4-0rlc RI J' b,
Print or 71ype Name
CLe'A cfi_
Mailing Address
&JLE/I Ci 124- 28's`S?
City/StatelZip
70o 2 ©,2 - 5-0.�
Telep one Number/Email Address
l - 16
Date
(Revised: Aug. 2014)