Vota, Michael

�CAMA El DREDGE & FILL li 67538 A B (`-C--P') D
GENERAL PERMIT Previous permit #
New ElModification DComplete Reissue El Partial Reissue Date previous permit issued
As authorized by the Stateof North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NC
KRules attach
Applicant Name V ! " "16-' Project Location: County
L r .�: �
City
State 'CZIP'r- �5, NJ — .1
Phone # F-Mail
Authorized Agent
Affected 0 CW ,NEW )kPTA El ES 0 FTS
AEC(s): L1 OEA El HHF El 11H 0 UBA 0 N/A
El PWS:
ORW: yes /.I I n'o, PNA (�e / no
Type of Project/ Activity
Pier (doeWmetb
Fixe;
Float
Fing
Groi
Bulk
Basin
Boat
Boat
Beac
Oth
Shor
SAV
Mor.
Phot
Wain
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone# River Basin
Adj. Wtr. Body /(nail man /unkn
Closest Maj. Wtr. Body
(Scak-'
Platforms
N
0
MEN
NONE
NOON
11111
0
No
WON
No
01011011NE11"NE
cubic yards
ramp
ENE
No
MEN
N
MON
N
N
NERENION
WEREMENNEEN
-linel-ength
not sure no
yes
torium: n/a yY no
Fs: '4 no
y
--r Attached: yes n
A building permit may be required by: t U. El See note on back regarding River Basin 'rules.
Note Local Planning jurisdiction)
Notes/ Special Conditions 0
(A� g �2f or Aq pplicant Printed Nam Permit Officer's Pri6ed Name
Signature "Please read compliir ce statement on back of permit" Signature 1.
till
Application Fee(s) Check # Issuing bate

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, certifythatthis 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 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-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.nccoastalmanagement.net/
Revised 08/27/14

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date V �- �✓ — l�
Name of Property Owner
Mailing Address:
2 0--r1e
lying f r Permit:
I certify that I have authorized (agent) 'rom 6.94AAW3 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 6 0-0), 14 I ,
at (my property located at) jyo Rr_a `$ (,Al
This certification is valid thru (date) S,eP7-
El
Property Owner
l - 015 .
Toe--s� G- ors
Date
RECEIVED
JUL 171Q15
0�90440Q CAM

ADJACENT RIPARIAN PROPERTY DINNER STATEMENT
hereov--erti- +hat 1 own property adjacent to 4�' _ s
roperty owner`;
property located a
(Addles-s. Lot, Block, Road, eta) _
on I~ C �' �, in__
tWatarbody) (City/sown andlor 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 rill in description below or attach a site drawing)
60#r 'w rl-
WAIVER SECTION
I understand that a pier, dock, mo6ring 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.
(Property Owner Informaa� tio�p)(Adjacent Property Owner Information)
Vd!
Print or
MailiOg tqdress S'l6
City/State/Zip
Telephone Number
A'3 S - GO-�49
Date
Signature%/ B zq ` �v
Print or Type or Type Name v
Mailing Address RECEIVED
Ar
City/State/Zip JUL 7 1015
Telephone Number
2 8--- T
Date 7C / 7
(Revised 611812012)

CERTIFIED MAIL, RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
:ADJACENT RIPARIAN PROPERTY OWNED NOTIFICATIONJIPJAiVER FORM
Name of Property Owner: _.njrrHA*
Address of ;property: iYd I?"t
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Tdm 64442*-03 Mailing Address: J®7 u,">✓i~Aj
Agent's phone #: 2— y— 5?31 Pouia sv«�. All G 21W
i hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter
have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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.)
-� do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
;Iigna�tvre
Print or Type Name
r1IiC1r1-d'e-c
Mailing Address
/C16 1�4,f r .44�10-0- � �-
City/State/Zip. "
&'e Z grl6 -? - 6o�Q
Telephone Number
04 � S o l .s
Date
Signature
Print or Type Name
Mailing Address
r Ii
City/StatelZip RECEIVED
D 3 �C7 O 4, `3 JUL 17 2015
Telephone Number I,
7/��ft5"
Date
Revised 611812012