Vernon, Eric

CAMA / ElDREDGE &FILL v �' v "NO V�~
A BC ..•' D
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 , r o,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
les attached_
t , •,
Applicant Name ' �f : Project Location: County
Address { • "� R ` """ Street Address/ State Road/ Lot # s
1 ry
t ! i ) i Ia N
City `` f ' € ) State ZIP a r%`r �.
Phone Subdivision m,
Authorized Agent City f ra f }'` 1 �; ° ' �'`�' SIPa
' Affected ❑ CVN'EW PTA ❑ Es ❑ PTS + Phone # ( ) River Base},,
❑ OEA ❑ HHF ❑ IH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body f d',% Aj (nat )/man /unkn)
f
Closest Ma1
ORW yes no PNA yes /' no '. Wtr. Body° ' I(- , ; ' ey i FJ (Y
am—
' "� rat'^ ;:•.:" a^,,t"rm '°�,....^ ::u.:p
Type of Project/ Activity ''b r a . • d, t` r i � f
f:.. (Scale: dr )
Pier (dock) length 0
Fixed Platform(s) O`, — -- —
Floating Platform(s)
p Finger pier(s) ".^
....... ..... ...... ...... ......
Groin length
number
Bulkhead/ Poprap length ,,,. . - -.._.. _.-_... --.-.._.. .-..-- .--- -_.-- --
avg distance offshore
max distance offshore
Basin, channel J
✓'"
cubic yards
Boat ramp
Boathou Boatlift=
Beach TBIIT!ng ' ` S ^"®, • i `^? t �
t
Shoreline Length
I
SAV: not sure yes no '
Moratorium: n/a yes no — —
- - - -- — ..._.__.................
Photos: y no.
�.._.._
Waiver Attached: yes no
A building permit may be required by: $ f4 ,_•., j .h rf ...�-'` See note on back regarding River B in rules. t
Note Local Planning Jurisdiction ; ., t-A r • G M yy ` 1 r , ,
to 1. f 1 /,
Notes/ Special Conditions i`'a p�
r`•` i i '�Fi Yr�'tf
.. {' a 4. ,.� r. •r 3•... iu� q ' i'•.� Q,.r,t ,pµ} Jay
.P
(:,:Selz or Applicantrinted'Name Permit Officer's Printed Name... a J`
ngLture `.* e read compliance statement on back of permit Snjtr� A
App6cationFee($) Check#� Issuin Da a Expiration Date

t
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 I) 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
landowners).
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 0 Other:
El 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 (252-946-648 1 ) 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/ 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.nccoastaimanagement.net/
Revised 08/27/14

101, of -
, l
1)

,4
Pat McCrory
Governor
e
North Carolina DepartmeWUNR
nt of Environment and Natural Resources
Division of Coastal Management
Braxton C. Davis
John E. Skvaria, III
Director Secretary
Date_- I --,'I('
Applicant Name �1' �L�Ij
O�j
Mailing Address / a0 Wp '„�� 'po IN-r-
`F'14 l ( �2- G t 2
I certify that I have authorized (agent) � L'O&C KJ tt w to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install,or construct (activity)
©� C� �'`''� �',►�� , at (location)
�/--c- 'e- X'0 II
This certification is valid thru (date)
SignatureU
- C. 2T'ci 1 rZ
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
RECEIVED
OCT 14 2016
DCM- MHD CITY
RECEIVED
OCT 0 5 2016
ITY
One
NOA-hC' u6i na
Avow�

y
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I awn property adjacent to >r i c A , UP- u t., o tj S
fl ( of Property Owner)
__
property located at Oq Go I+o� � ea
(Address, Lot Block, Road, etc.)
on. Sovn� , In_ %� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_ % I have no objection to this proposal.
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)
I
r e✓ � �.� � � �
�yx
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, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. RECEIVED
I do not wish to waive the 15'setback rWyiremg4t? OCT 14 2016
(Property Owner Information)
v
Signature
Erie A. V12Nou
Pr' t or Typ ame
?lob -For)14-1
TinyAddress
C' /State ip
III 9Y7 4 -)-Zi
Tele hone Number% a l address
-1s«
Date
*Valid for one calendar year after signature*
Owner Info_ M H D C ITY
or 1 e�(6 RECEIVED
XJ'd7
OCT 0 5 2016
R I
Pbne)Numberl efifail address ° r" A M H D C I
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(J:1y__A_"7QA&T_rRf- col"4'r
1 hereby certify that I own property adjacent to LI-1
K
(Name of P:rMperty Owner)
property located at 1 © A 0 L4 L,v- oa `D Go v
�y (Address, Lot, ock, Road, etc.)
on in — i1_5 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development rust fdl.in description below or attach a site drawing)
_RECEIi/E®
OCT 0 5 2016
WAIVER SECTION ®C M - IVI I -I ® CITY
l 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. (it you wish to waive the setback, you must initial the appropriate blank Belo
DECEIVED
do wish to waive the 15' setback requirement:__
,A()f^ I do not wish to waive the 15' setback requirement. OCT 14 2016
(Property Owner Information) (Adjacent Property Own hift.118q U C ITY
Sifflw1we Signature
I C -A- Vv--r ry ano ..
Print or r Type IV e r
6t� rn FRa1: or;
aili Address ;
Ci /Scat
Arl %) - 41 Z 4
Telephone Numl r/email address
Date
*Valid for one calendar year after signature*
s0ft A. mezeao
Prix) t or Type Name
610i CdAl 4R.
Ma#ing Address
"415%6/f /►t G 27612
City/StatelZip q11 187019
Telephone Number/email address
9/'L 06
Date*
(Revised Aug. 2014)