Vernon, Jimmy

kCAMA / ❑ DREDGE & FILL 62723
GENERAL PERMIT Previous permit#
15�New ❑Modification ❑Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources ,ter T f r y�0
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f
_ p Rules a ched.
Applicant Name; 1 ' r Project Location: County 1
Address n � . 7 C %6'1 Street Address/ State Road/ Lot #(s) r '77 Y` 11(1^1 'l/ N-,
JL
City 0115 State ZIP ' U /
p
Phone # Fax #
Authorized Agent / / rrv' N, '1 f t 0' jt!,
Affected ❑ CW "" 6 EW —L PTA AQiS ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWs: ❑FC:
ORW: yes /Co"' PNA yes / a ` Crit.Hab. yes / no,
i
Type of Project/ Activity I!
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathous Boatlift" rl T i
Beach Bulldozing
Other
;Shoreline Length f
iSAV: not sure yes' fior':
Sandbags: not sure yes o -
Moratorium: n/a yes °.
Photos: yesnQ
Waiver Attached. ¢ 6
_ no 4
A building permit may be required by:
Notes/ Special Conditions �� I%`?
Subdivision
City. - try • `a ` ZIP
Phone # River Basin /•_I �' �`�- rrc
Adj. Wtr. Body*!' , / ( )
!Dc �r'1 nat /roan./unkn
Closest Maj. Wtr. Body
(Scale:
0
0
❑ See note on back regarding River Basin rules.

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 andvoid.
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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules
❑ Neuse River Basin Buffer Rules
❑ Other:
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 Quality. Contact the Division of Water Quality 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
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(Serves: Carteret, Craven, Onslow -above
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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: Vernon
Date: 8/13/13
General Permit #: 62723C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
OW
Dredge ❑ Fill ❑ Both ❑ Other ®
25
25
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanaaement.net revised:02/03/10

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ---� -- l (- -- 13
Name of Property Owner Applying for Permit:
yr rr� L,y e- o -1
Mailing Address:
L2 -� -9c,-,m - , 72, ,10
G o t ca b-�a 1j. c. 21 S'30
I certify that I have authorized (agent) it v 0 6 t-- <- K iL 1),-Lrj e, , �-, -r,, to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Signature
\ m, V -¢ n r -o w P A -H—, fU -Cl—
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to 1 Yni Irma s
(N me of Pronertv Owner)
property located at J-3S L b l c f l
(Address, L
on in_
(Waterbody)
Road, etc.)
(City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
locatjen.
V I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
R
Y-L
t'►i'-i-
WAIVER SECTION
I 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
ED
=rd 'ZAJ do ro .
City/State/Zip � 9aa a �a o
Telephone Numbe
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
/37 6.o 1a 04/ -z .
Mailing Address dr
P"/Ve—k 1�ak'p—S
City/State/Zip
Telephone Number
MIMI
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f�l M M 1C \J -0 a +V 's
(Name of Property Owner)
property located at 1 -4 5 Lt. h l o l 1
(Address, Lot lock, Road, etc.)
on Z a *- n L_ , in lock,
Is N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
V— 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)
L goD,1 e 5ley Z, � t
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, rift, or groin must be set
back a minimum distance of I& 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.2, 1 do wish to waive the 1 V setback requirement.
I do not wish to waive the I & setback
Azm ri X
Telephone Number 6
7•-/� "lam
Date
Owner information)
or Type Name n
7gAddress
I CIA A �2?
Date