Breedlove, Steve

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JCAMA / ❑ DREDGE & FILL N2 70973 q g C D
GENERAL PERMIT Previous permit#
EJNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 11,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC `�
[]pules attached.
Applicant Name ( t Project Location: County
Address s S . ' _ Street Address/ State Road/ Lot #(s)
.. i
City'(,' State`' ZIP
Phone # ( ) E-Mail Subdivision
Authorized Agent 4C`� " ?<' City ZIP
❑ CW EW >rA ❑ ES ❑ PTS Phone # ( ) River Basin
Affected ❑ OEA ❑ HHF ems❑ IH ❑ UBA ❑ N/A i
AEC(s): Adj. Wtr. Body r �' � � ��' i � ;_ `(nat /man /unkn)
❑ Pws:
Closest Maj. Wtr. BodyE " ° -
ORW: yes / no PNA yes Vna3
w
Type of Project/ Activity
(Scale:
Pier (dock) length t
Fixed Platform(s) ?
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
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
1V_ r
Agent or Applicant Printed Name Al
e
Signature Pleaseread compliance statement on back of permit
`� 7
Application Fee(s) Check #
note on back regarding River Basin rules.
PermitOfficer's Printed Name
ell' --
Signatu
l 71 �
f« ,6. 1 n'4 Exibiration 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 252-946-6481
Fax: [phone] 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
(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
)ILL
Phone Number:
Email Address:
1 certify that I have authorized % l < S
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: LI�� /� r� �✓�'1
at my property located at 2
in County.
1 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
Print or Type Name
Title
b Z 1 2, I /�
Date
This certification is valid through 1. I

UtRTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to eC
Property located at
(Name of Property Owner)
�� pl/L x?
on (Address, Lot, Block, Road, etc.) �y
in
(Waterbody)
Agent's Name #: zz �v►c <
Agent's phone #: 2
(CItylTown and/or County)
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location, and I have no objections to the proposal.
-------------------------------------
---
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in�Qlescription below or attach a site drawing)
-j�, " ��
/fyou have objections to what is being p oposed, you mustnotify the Division of Coastal Management
(DCM) in writing within 10 days of recelpt of this notice. Contact information for DCM offices is
available at httn://www.nccoastalmanagement net/web/cm/staff listing orbycalling 1-888-4RCOAST. No response is consrdered the same as no objection if you have been notified by Certified Mail
(Pro rty Owner In rmation)
Signature
Sf,e-A-
Print or
Type
/Name
Marling Address
d l C y
City/Stat Zip
Telephone Numberl Email Address
Date
(Riparian Property Owner Information)
&n—
Signature
Print or Type Name
Marling Address -
City/StatelZip
Telephone Numberl Email Address
Date
(Revised: Aug. 2014)

am
ULRTIFIED MAIL - RETURN RECEIPTREQUESTEDrvKidi
I hereby certify that I own property adjacent to `
Property located at
(Name of Property Owner)
(Address, Lot, Block, Rqad, etc.)
on /� cf<< ter;' ��f7 in , ?
(Waterbody)
;� Agent's Name #: {City/Town and/or County)
� r�� �...� �
Mailing Address:
Agent's phone #:
He/She has described to me as shown below the development he/she is pro osin
and I have no objections to the proposal. P g at that location,
(IndiviDESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
dual proposing development must fill in description below or attach a site drawing)
if you have objections to what is being propos , you mustnofify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available se. is considered
astalman-ye rt?ent neVweb/cm/staff listing orbycalling 9-888-4RCOAST.
1�10 response. �s consrdered the same as no ob ectton if You have been notified by Certified Mail.
(Prop rty Owner Inf rmatio%n)
..Signature
not or Type Name
Mailing Address
Ci y orn eicip
Telephone Number/Email Address
Date —
(Riparian Property Owner Information)
Signature
6771 /,1 /, l /_L O11 G1
Pn//n��t or Type Na
Mailing A Tess _
Crty/State/Lp
o — s 77
Telephone Number/Email Address
Date
(Revised: Aug. 2014)