Whitehurst, Jason

P.:
D CAMAV/ F-1 DREDGE & FILL
67564
GENERAL PERMIT
A B
Previous permit #
(C D
�Npw OModification DComplete Reissue E]Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Applicant Name. JI()q
Project Location:
[niftles attached:
County
F
Address
Street Address/ State Road/ Lot #(s)
City e $tat ZIP
ty
ti
Phone #
E-Mail
Subdivision
f
Authorized Agent
city.
zip
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E� ES
Phone#
`fiver Basin'
Affected
El OEA 0 HHF DIN 0 UBA El N/,A.
AEC(s):
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ORW: yes / ho�.. PNA yes n?
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'10001

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 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 how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-8884RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District.
1367 U.S. 17 South
-f lizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(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

AMA / 11 DREDGE,& FILL
PERMIT
67564 A B
D
WewNERAL
❑Modification ElComplete Reissue
Previous permit #
❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
'
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC .
Applicant Names �cj Y "'
ules attache
Project Location:, County t, `
Address
Street Address/ State Road/ Lot #(s)
City f ;`Mate i ZIP
_
F
Phone# E-Mail `�-"""'---
-.
Subdivisjo
a
Authorized Agent f
, ;
i 1 �_r
City :J 4 Ct ZIFI.� i
Affected OCw El ES 0
Phone # fver.asin ;i ,
AEC s : ❑ OEA ❑ HHF ❑ I ❑ UBA ❑ N
�)
Adj. Wtr. Body G . ; _
an
❑, pW
at
n"
ORW: yes / o PNA yes / n
Closest Maj. V1/tr. Body - 1
s
Type`of Project/ Activity -' �c
Pier (dock) length
Fixed Platform(s)""'""'""' -
Floating,Platform(s)
Finger piers)!:
Groin length -*^
number*'"
Bulkhead/ Riprap length
avg distance offshore
max distance offshore'—'"
Basin, channel *-»
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing""""'
Other )e�54

all.AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit:
Mailing address:
112, &wgn St
ME
Telephone Number: III- 6 H "-2-�bq
r
I certify that I have authorized G�-°`""� (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at 1 �J Z--,� �rl�
This certification is valid through r l
(Property Owner Information)
x
Signature
Print or Type Name
Title, co. owner or trustee for property
C0 — (- ri�
Date
I � i - w 1%
Telephone Number
LnV\
Email Address
(date).
RECEIVED
JUL 2 9 1015
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i�
WAIVER SEGTION
l 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 y
wish to waive the setback, you rnust initial the appropriate blank below.)
do wish to,waive the 15''setback requirement.
do not wish to waive the 15' setback requirement.
RECEIVED
Owner Information) (Adjaoe caner Info ion) JUL 4 9 101"
(Property .
1 r
gr�dture Signature _
rs
Print or Ty e Name Print or 12—
Uj Pe Na
_3Z 1. �� M7 � ilin Addres r^,�n. T-11 n_'L `v l--
Cit /State%Z�p
Telephone Numbe
Z S Zo r
Date
Mailin Ad Press j
t
City/State/Zip g
Telephone Number j
Date
(Revised 611812012)