Welsh, Brad (2)

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L CAIMA / ❑ DREDGE &'FILL A B (C D
GENERAL PERMIT Previous permit #�
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issuue"d."....
As authorized by the State of North Carolina, Department of Environment and Natural Resources' l �i
and the Coastal Resources Commission in an area of envirore tal concern pursuant to 15A NCAC�'
Rules attac d.
t = t ' i Project Location: County
ame Applicant Nj
Address t i� d �� j i". Street Address/ State Road/ ,Lot #(s)
` I
City 'A, (' s� State , `, `', _ZIP i l
Phone # (�� r 1111_ E1 lail ��� �' Subdivision 1 ' t
l !I f y Authorized Agent City ZIP w% ,,7. v—,
❑ CW *IV TA
❑ ES ElPTS Phone # ( ', 1: iver Basin `•. 1 ','
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A l `o �� ' A I
AEC(s): Adj. Wtr. Bodyt. t ti 'n!(nat /than /unkn)
ORW: yes / no ) PNA yes / n
Closest Maj. Wtr. Body
Type of Project/ Activity �% i ; x [ ? (
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) i/`{T
r 7
Groin length
number —
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp — -- "
Boathouse/ Boatlift w.
Beach Bulldozing
Other
Shoreline Length f L'
SAV: not sure yes b!';
Moratorium: n/a es
_...
Photos: / yes w o
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning Jurisdiction) )
Notes/ Special Conditions
f A,
❑ See noxe on back regarding River Basin rules.
I f¢
%`
ie
ration 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 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
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules El Other:
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 howto 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

qpeoTrrojec-j,k&4cz%vq_� 1k, % —
Pier (dock) length
%
fixed Platform(s) I -men
It V OMEN :mmm:
Floating Platl`67(s...w.............�
-t— -
Finger pier sj 0
ngti
roin le IMIOM
number
Bulkhead/ Riprap length
=11UNININJAININ 1
iNION
avg distance ciffshore
m ax distance offs hore
Basin, channel
cubic yards
boat ramp
Boatho6 INEME E I Erma I I MENFAIJKLIDUE
se/ Boatlift
1ANFE6 z OMNI SEEM
Beach BuA!dozing
MENNEN! RINEE WENNIrsims
Other
Shoreline Length I V
SAM not sure yes
Moratorium: n/a es 42
V yes 's
s
Photos: yes 0
—
Waiver Attached: s 0 . . . .
ye . jso
A building permit 'may be required by:
(Note Local Planning j urisdic tion)
Not
et/ Special Cpnditions Ilk'
k I/I UA
Ire
LIZ )�tll
Perm
S.
6 ad,compliance stati�mentohb:ac'.kofpel'mit** )igna u is sui
ng Dke..
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ESEEMMEMON
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WMEMWEMNMI 1 ing ln&wlei on bPQgN ki
E�pl&iod D.

AQE11tT AUTHORtznTInN Pr)RM FOR �EtMiT APPL1CATfQNS_
Name of Property Owner Apr
Mailing address:
Telephone Number:
I-
V-1
i ...
�o�er� S • 6✓�S
t cer#, Y that 1 have authorized .-,"(agenVeontractor),
to action my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at myiproperty located at, P,�{/%�
This certification is valid through
Owner Information)
S4 tur
IC
1 Print or Type Name
Ye, co. owner or trustee for property
r
Date
4kii - -9l z -
Telephone Number
3:��•�;Sil�ltj[ .r s►'M
RECEIVED
FEB 01 2016
RECEIVED
JAN 2 2 2016
f%�" f7ITY
(date)

ADJACENT RIPARIAN PRt
i
herby certify that I own property adjacent to
pro located at 120 3'n/
I (Address, Lot, Block, Road, eta.)
on ??and , 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.
1 have no objection to this proposal.
{
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(1ndi�idual proposing development must fill in description below or attach a site drawing)
I and
must
me.1
Date
1_ , (Name of Property Owner)
<5,, R-It6o4a
WAIVER SECTION
:rstand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
)e set back a minimum distance of 15' from my area of riparian access unless waived by
f 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.
rA
' 'Valid for one calendar year after signature`
r
(Adjacent Property Owner Information)
x
/w , f
StRECEIVED
y
Print'or Type Name
Mar;ggAddress , laDCM_ MHD CITY
T City/State2;
x Telephone Number/ email address
1 - /G -ho
Date'
(Revised Aug. 2014)
RECEIVED
JAN 2 2 2016
DCM- MHD CITY

ADJACENT R1N PROPERTY OWNER STATEMENT-
-I
hereby certify that 1 ovM property a scent to 1d'Gl.S * 'S
[Name of Property Owner)
pr
on
The Ippiicant has described to me, as shown below, the development proposed at the above
to
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
proposing development must fill in description below or attach a site drawing)
RECEIVED
FEB 0 12016
WAIVER SECTION DCM- MHD CITY
mderstand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
ust be set back a minimum distance of 15' from my area of riparian access unless waived by
a. (if you wish to waive the setback, you must initial the appropriate blank below.)
i do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
y �Owner f fo ation) (Adjacent Property Owner Information)
Yi ature *
ae�Name r � Print or Type Name
Tress i Mailing Address
ML-1 91'Z 411S. -7
phone Number/email address
X City/StatelZip
q0 4- Telephone Number/ email
ill address
% - f-6, /A
Date*
(Revised Aug. 2014)

_ ID
RECEIVED
JAN 2 2 2016
DCM- MHD CITY