Welsh, Brad

CAIMA I DREDGE & FILL
'
TO 66411 2 A B D
7 ENERAL PERMIT Previous permit # El
ow. ❑Modification ElComplete Reissue El Partial Reissue Date previous permit issued
As aut orized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resou1.rces Commission ig an area of environrrilmtall concern pursuant to I SA NCAC
0 �ules atia Ki d
f
Applicant Name Project Location: County
AddreSS Street Address/ State Road/ Lot #(s)
City State ZIP
C I
Phone # Subdivision,
Authorized Agent city zip
EI Cw E'hW [)�PTA ''' S El PTS Phone # �111"?" Rj)Tr Basin i
Affected
/)
(
0 OEA 0 HHF El IH 0 UBA 0 N/A nat fia�n--
Unkn
AEC(s): Adj. Wtr. Body
0 Pws-
Closest Maj. Wtr. Body t�li
no PNA 0 ORW: yes yes /(n I --I I
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length.—"'—'
ti Bulkhead/,Riprap length'
----aVgdistance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift,1.,,,....".
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no,
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdict
Notes/ Special Conditions
1�4141�/5 At
Agent or Applicant Print
i, �Name P
Signature ",Please read compliance statement on back of permit** S
Application Fee(s Check # Is
(Scale:
&i%.#IVI— IVI"Li %we I
❑ See note on back regarding River Basin rules.
-mityniperl rnnteair4arne
ire
E. 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 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:
0 Tar - Pamlico River Basin Buffer Rules ❑ Other:
0 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 how to comply with 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

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3
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I tirationate

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: BPAD
Mailing address: l�
Telephone NumberOy� _
I certify that I have authorized i���tzT� 6-116EB (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development offl W aPl t_L
at my property located at /01 D Pbt& 1>12- 01-41t-tj') c— 1811--J"T
This certification is valid through
(Property Owner Information)
Signature
Print �orType Name
IN
Title, co. owner or trustee for property
Date
(date).
RECEIVED
DEC 0 4 2015
DCM- MHD CITY
(fir-' �2rin
t=3V2- �4G0C'
Telephone Number Co
S
Email Ad ress
RECEIVED
DEC 0 8 2015
DCM- MHD CITY
AU&U&=A.IA'Aj�A # A�AaA [A`JA A§AAAA • ®��®��®a®�{i 0®S®S®' ®��®i ®�®

I.hereby certify that I own property adjacent to ff *k "-/S 's
property located at
on
(txyt i own anwor
The applicant as 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)
Se4-w*' i'
L1.�c�1
WAIVER SECTION �Q
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.)
RECEIVED
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement. �" �015
r� w a
(Property Owner Information) (Adjacent Property Owner I tinny p CITY
Signature Signature
Date
*Valid for one calendar year after signature*
Print or Type Name
Mailing Address
L
RECEIVED
DEC 0 8 2015
City/State/Zip
Telephone Number/email address C M- M H D CITY
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ l> 0 ELS F1 s
(Name of Property O ner)
property located at 1 D PD t4b DIZ--�fL�PI NTI �- $c1-y
(Address, Lot, Block, Road etc.)
on r TEE �01��%• • , in lfhLAOTI C. cR C , N.C.
(Wate.rbody) (�!ty/Town an/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)
t.0
6
- - - - - - - - - - - - - - - -- - - - - - - -
c p LIECEIVED
WAIVER SECTION W � CI_ .
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 wai 4
me. (If you wish to waive the setback, you must initial the appropriate blank below.) }a-iD CITY
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
.34!.A-D u 'c.sti
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number/email address
Date
(Adjacent Property Owner Information)
'Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number/email address
Date *
DEC 0 8 2015
®CM- MHD CITY
(Revised Aug. 2014)
*Valid for one calendar year after signature*