Brown, Jarrett

!-V
CAMA / ❑' DREDGE & FILL N2 70970 A B C D
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality —? / %� µ,
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �"1 (/� ules attached.
Applicant Name Y L' �. + 'i- .fit Project Location: County
Address Street Address/ State Road/ Lot #(s)
CityState ZIP f ...
Phone # E-Mail Subdivision
Authorized Agent City ZIP " r
[ICW ElEW ❑PTA ElES ❑ PTS Phone # O River Basin,
Affected AEC(s): El ❑ HHF ElIH ❑ UBA ElN/A
Adj. Wtr. Body f'y (nat /man /unkn)
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) X
1
Finger pier(s)-
Groin length .
i
number
Bulkhead/ Riprap length
avg distance offshore i
max distance offshore
Basin, channel _ A
cubic yards
Boat ramp w +
�r-
Boathouse/ Boatlift
Beach Bulldozin
Other^ !
Shoreline Length !
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
a
Agent or Applicant Printed Name
r .s
Si cure Plea! read compliance statement on bark of permit
Application Feels) Check #
(Scale:`
❑ See note on back regarding River Basin rules.
(-V f /
Permit Officer's Printed Name /
Si natur
Issuing Date piration 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, 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 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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/ 17

Information)
ADJACENT RIPARIAN PROPERTY OW ER STATEMENT
I hereby certify that I own property adjacent to s
(Name of Property Owner)
property located at L) �1
I (Address, Lot, BI k, Road, etc.
p)
on 1 ate kvio l I �4,nc t' in Y cm � L144 N.C.
(Waterbody) (City/Town and/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)
WAIVER SECTION
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
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent
�-zjtd
S' nature /
J61 r,�e �✓l

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C "r��;�� % / , I&E 0 WA-1 s
(Name of Property Owner)
property located at 1 O 5 /-1y CI.�oRX
(Address, Lot, Block, Road, etc.)
on , in- /�i�'.E KNOLG �5'�G��F_s N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
x 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)
WAIVER SECTION
I 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
wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
X I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
/O3 C/<O/'4�Y cocwr
Mailing Address
i�i1Vf=�c roc c .5 rlO2ES �(/ C- 85 i Z
City/State2ip
Telephone Number
-
Y-'� _/S
Date
(Revised 611812012)

- S,k""f