Warren, William & Millie

,CAMA El DREDGE & FILL
N1 67004 A B D
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GENERAL PERMIT Previous permit #
ew El Modification ElCoirnplete Reissue ElPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
q
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attaFhed.
Applicant NamekYll(�-a) I L�l ik?,( Project Location: County k r,
Address—i Street Address/ State Road/ Lot #(s)
city t Statq_,�( Zip
Phone # VIE -Mail Subdivision
Authorized Agent ZIP P
El CW 1B E1W
� PTA
Affected
AEC(s): 0 OEA El HHF
El 1H
El PWS:
ORW: yes /'o PNA yes
Type of Project/ Activity
ks''
El ES 0 PTS Phone# :V'River Basin
El USA E3 N/A
Adj. Wtr. Body (6at /man /unkn
Closest Maj. Wtr. Body
U
(Scale:
rier koock) iengcn
Fixed Platform(s)
Floating Platform(s),III
Fingerpler(s)
Groin length
number
Bt4!khead/ Riprap length
ayg distance offshore
max distance offshore,
Basin, channel
1
r
0
NO
ONEMEN
10*1
No
cubic yards
Boatramp
Boathouse/ �oatlift) 4 (-Ij
01
NONE
MMMMENINNE
0
Beach Bulldozine—_
Other'�
MEN
No
No
in
No
ON
N
Me
AL&MENNEINEENE
Shoreline Length � U` -
SAV- notsure yes (w
Moratorium: n1a P(�n,��
y Photos: yes
Waiver Attached: no
NONE
��e■m�wo��e����m��nt�Cam���
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Coqditions 6'
Agent or AppfiAnt Printed Nam d
Signature Please read compliance statement on back of permit
Application Fee(s) Check#
El See note on back regarding River Basin rules.
17k, I
cer'sprin*"Name`
,
Issuing Dad Expiration Date
a,

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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules
El 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

Y_

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: W I UQn \ffaVYW aid W lu e WSW'
Mailing address: tk k -6e01 TyqC2 ---aVW
k"l C 2c�5� fl
Telephone Number: C���) 23�_ --YE)-I
I certify that I have authorized M I k" Peylyl I (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of Mau%n e ask,^..A 1?;o,�'V-f�
at my property located at i li KU 1-ClU LO VLF f Ne WTov - NO 2, Q)51 o
This certification is valid through -7" 30 ^ Z0 I b (date).
(Property Owner Information)
�MKQW- � ',w �M RECEIVED
Signature SEP 0 81015
Print or Type Name
RECEIVED
Title, co. owner or trustee for property AUG 2 5 2GE
Date
Telephone Number
Email Address

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to �, r re 's
(Name of Property Owner)
property located at _j,, � e- ,ram (r ,
(Address, Lot, Block, Road, etc.)
in tAJe,-,2 Q04-�- °N( Z 5 7y N.C.
(Waterbody) (City/Town and/or County)
Agent's Name* _rA gLl MailingAddress:.
Agent's phone #: zS 2 i-(Z2 �.C1f j C'Zi �ea c Zo k 6
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 development must fill in description below or attach a site drawing) !�LAks
6
If you have objections to what is being proposed, you mustnotifythe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at httollwww.nccoastalmanagement.netlweb/cm/staff-listing orby calling 9-888-4RCOAST. RECEIVED
No response is considered the same as no objection if you have been notified by Certified Mail.
SEP 0 81015
=�rtly0w� io) i arian Pro erty O r Information)
ignature RECEIVED
Print or Type Name
IVIalling Address
vve,)_PL,;,(+ �J�- U5-7 0
CitylStat Zip
�( D-- Z32. 35-7
Telephone Numberl Email Address
Date
3. lk 7vA- 6" AUG-2 5' 1015
Print or Type Name
Mailing Address
City/StatelZip
Telephone Numberl Email Address
mac)- �x S'
Date
(Revised: Aug. 2014)

ADJACENT RIPARIAN PROPERTY Oia!lNER STATEMENT
hereby certify that. I own property adjacent to W\
.�::..-_:. ;;..:,... rpr�perty.I�.4.�tecl.�t�,,,,;,�,: � a•C-e.. - � ,.�._.�....:,...__. ,..._.�.._. ,w.�....:... ...�.�
(Name of Property Owner)
% -.-.., ---7 -7
on �o� nG� in N.C.
—(Waterbody) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above _
I have no objection to this proposal.
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
0
IJ
� � S
0
RECEIVED
SEP 0 81015
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lift; or groin must b�
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.) RECEIVED
I do wish to waive the 15' setback requirement. AU6 2 5 2015
1 do not wish to waive the 15' setback requirement.�`�°"i"
(Property Owner Information) (Adjacent Property Owner Inform atign)
�Wul
Signature
Print or Tye Name
Marling Address
A)(, 7Q
11,S—tacelzip
0 Z3 Z 3 576
Telephone Number
. `7— Z9 - ze I
Date
Print or Type Name
� QQ� I --� -AFv, bc—M �A�J
Mailing Address
Cit /State/Zi � O
Te eph e Number
e
(Revised 6/18/2012)