Williford, Bernie

CAMA, / A DREDGE & FILL t ,� g � .f
/ �kD 181 A B D
F,� �._
aG..ENERAL PERMIT �/�/ f �� b Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued '
As authorized by the State of North Carolina, Department of Environment and Natural Resources r
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ; / q-- � # /-/ '
OlIRules attaS Y�I
Applicant NProject Location: Couname I County
{
...i'' r
Address_, r
Street Address/ State Road/ Lot #(s)
City ':. o 4 ' ZIP • F' u.
��.,. State �.�
Phone # E-Mai l Subdivision r'
Authorized Agent '' City ZIP
�a
Affected ❑CW �;❑p `IA I€s f,a# S Phone # ( ) r' � River Basin
❑ OFA ❑ HHF ❑ IH ❑ UBA ❑ N/A i "c'
a r r' m
AEC(s): Adj. Wtr. Body $� r { s �(nat )unkn)
1-1 PWS: +'
RW: ye;•- no,' PNA yes / no Closest Mai. Wtr. Body
O`� rr
/r. ,
Type of Project/ Activity `�, K
Pier (dock) length
Fixed Platform(s)
r"
Floating Platform(s)
Finger pier(s)
Groin length
number
.FI ���T
-a'vg distance offshore "i �B
max distance offshore ;,.
Basin, channel
cubic yards
r
Boat ramp
Boathouse/ Boatlift 'r
Beach B Ili g
Other
Shoreline Length t
SAV: not sure yes / no
Moratorium: n/a yes no
Photos: yes 1 no
Waiver Attached: yes kt no
A building permit may be required by:
( Note Local Planning Jurisdiction) /� i
A Ki 7 •�' S w. ...� t/q 1 rixo..�P•. I•A�
W� fe
Agent or'Apphcanc Printed Name
LJ
S' nature lease read compliance statement on back c{f per
r.
plication Fee (s); Check #
e,� ❑ See note on back
Permit Officer's Printed Name y f'
Signs u e
Issuelssui g e
ing River Basin les.

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 ❑ 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
More 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.nccoastalmanagement.net/
Revised 08/27/14

CAMA /„`DREDGE & FILL
4 x + y
ERAL PERMIT
:� .- a D 0A B ;'. C� D
Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
As, authorized by the State of North Carolina, Department of Environment and
the Coastal Resources Commission
Natural Resources
and in an area of environmental concern pursuant
to I SA NCAC ." i'/ •--.w
� � � :. � �». � •
Applicant Name (+i '` ';
� ) 'Rules attachdd
=� -,..•
Project Location: County {'
Address ,
Street Address/ State Road/ Lot #(s)
City �19jState'ZIP:
V E-Mail
Subdivision'
Authorized Agent .
City ZIP
❑ CW W
Affected "s
Phone # () River Basin
AEC(s) ❑ OEA "❑ HHF ❑ IH ❑ UBA El N/A
Adj. Wtr. Body' w(v
nat t/mlunk�
ElPWS
ORW ye-/-1!k'-PNA yes / rnof
Closest Maj. Wtr. Body
Type of Project/ Activity t_w
�i
Pier (dock) length
�»
Fixed Platform(s)
°° ✓
Floating Platform(s)
Finger pier(s)
Groin length
°
nuTber
-1£ _ f
,alg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift "
Beach Bj�II i g
Other [
(Seale: �' )
i I
MEN ■ ■■■■■ ■■ ■ ■■■■■■■ .■■.®.■■.■. ■lo■
. w
r� �■ ■ any , ■�■�■■■fe i�ur■.■■■■® s■
f
Shoreline Length
SAV: not sure yes/ no`.
f
Moratorium: n/a yes no
Photos: yes no
JIA
Waiver Attached: yes `; no/
A building permit may be required by:
( Note Local Planning Jurisdiction)
otes/�Sipecial Cond' ions i
❑ See note on back regarding River Basin ples.
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p �
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{ # ��aj
j C � '"n�97:t
nt o 'A lic n rinted Name f r.,
� � � � PermitOfficersprinted Name
ature " lease read compliance statement on back cif permit r
1, �yq
Check # Is!
c aa, ,s`
iatu e ;
t
ingD# 1 :expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 2 iiitd 1 Q ; U ,f-ov � 's
. /I I I \ r.(Name of Property Owner)
property located at
(Address, L t, BI ck, F. d, tc.)
on `'ice !� �- �c,tNCa - ( , in j tiio �� -4c.
(Waterbody) (City/Town and/of County)
The applicant has described to me, as shown below, the development proposed at the above
location.
LM1 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)
0 ( JP-C,- � - C-11k
OCT 0 5 2016
IBCM- MHD CITY
WAIVER SECTION
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.)
I do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
(Property Owner Information)
S.ig�nature
Print or Type Name ;�
J 1,
Telephone Number / email address
Zo (lo
Date
(Adjacent Property Owner Information)
Signature
c
Print or Type Name
, ,,- 9r 7
Mailing ddr ss
and LJ PV& v ti p,. C -1kl$/.Z
City/State/Zip _
Telephone Number / email "address
2U/,6
Date*
(Revised Aug. 2014)
*Valid fnr nnp ralPndar vpar after cinnafiirP*

I hereby certify that I own property adjacent to L),e k- J 1 160-- i4r. °s
((�r ([damef Propelrty �wnor)
property located at � � 4 f�t/n1 V .YJa h V r
(Address, L `t, 0I ck, Ro dMrfe
)
on I`i �c'NCc� , in a
'qG C.
(Waterbody) (City/Town and/o County)
The applicant has described to me, as shown below, the development proposed at the above
Jocatiah.
WAN (X I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing,4eve/opment must rill iWdes&idpdon below'or attach'a site drawing)
4)(a5
IDOc� RECEIVED
OCT 0 5 2016
DCM- MHD CITY
WAIVER SECTION
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.)
I do wish to waive the 15' setback requirement.
i/ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
S`a�gy�_ature r
Print or Type Name
1:1u a bVV,%),- "),-e��
Telephone Number/email address
9- a L- 2-0 1 t�
Date
Property Owner Information)
Print or TkAe Name
122 A �60'- 1.; J�s.D
t
ing dress
a, l9 dress
"
City/State2ip
Telephone Num er/email address
/d V h-I
Date* T
Yam aPtl��,
ti%
(Revised Aug. 2014)
*Valid fnr nnp ralpnriar vpar affPr cinnatiirP*

AGENT AUTWORIZATION & jkAMA PERMIT APPLICATION
Name of Property YOwner Requesting.Permit: /. ',hi`1�`v►rcl%
Mailing Address:1.-
Phone Number:
T
Email Address: 4-4 e �`_ if e, 0 1 to
I certify that I have authorizeda �„.,-•,P uc c
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 4�01AC-ie lv_azis= �
Loc� sz,4 f; 4 A or v t et e 1 l r
at my property located at -Pr' 64 0-0 1 � Yiv r P ,
in g�L County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
I, V- tj I'.' 0 , t- i ;
Print or Type Name
©w N Y—
Title
Rl� 8 l Zo
Date
This certification is valid through 12,, 1 3 1 1 1 (,o