Baldwin, Woody

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11 CAMA / DREDGE & FILL N2709$0 A B CC:
D
GENERAL PERMIT Previous permit #
EINew Modification ❑Complete Reissue []Partial Reissue Date previoys permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
1 (1—
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached.
Applicant Name_
Address --
City State _ _ ZIP
Phone #
E-Mail
Authorized Agent
❑CW
❑EW 0PTA
Affected
❑ OEA
ElHHF '❑ IH
AEC(s):
❑ PWS:
ORW: yes / no
PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_� X1
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 c
SAV: not sure yes no
Moratorium: n/a yes no
Photos: y�(ess° r no,
Waiver Attached: j►ess no
A building permit may required�b=
( Note Local Planning Jurisdiction)
Notes/ Special Conditions 11
_ /
st / 1
❑ ES ❑ PTS
❑ UBA ❑ N/A
Agent or Applicrt Printed Name
i
Signature '" Phase read compliance statement on back of permit
Project Location: County
Street Addres / State Road/ Lot #(s)
Subdivision
City ZIP---
Phone # River Basin
(—) -----
Adj. Wtr. Body --_(nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: I )
❑ See note on back regarding River Basin rules.
i t
Permit Officer's Printed Name
Application Fee(s)
Check# f Issuing

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

{r
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
0
L,Jua s I AI..o��
L /'bK2f Q�
(�I q - 4'D-1-- CS"�
Email Address:
I certify that I have authorized►-
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
04,11,
'
114
at my property located at SkaN'Z
in C-Kh �*County.
J- R" ' -- L
I furthermore certify that I 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:
tl Signature
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aC d I't -e':1 j //�A� -
Prin or Type Name
C) L
Title
a I 6 l�
Date
This certification is valid through 1,

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per -it
one
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The rdread t4 ine,..o; sly below,ise.deitrterit proposed a tho =3
I.ve no.-1geotion to,N;
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CE'VT RIPARIA J PRE3P.ERTY owNiMMATnENIENT '
i hereby cer ify ha, p p rty . 1. -2LL"L
Plpp�'tlF Owners
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property loc: tted at
Ac dry, Wit= Bloc caii, etc, f:
on
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a lf� ands
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nt Eld at h� above.
.�. Thy appl. ` it 11as desc-ib(,tl to me, as-. 3ht�vii below,'th� .delopma 1rr
,( fJ location . � ... • .: - : � . : . - . • _ • .. • • :::- -;
1 hay o no ob. eadop to-tho -proposal: °; t
1ha4is. objeeiionstoth!sproposal.
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IMP11:DEVEI.OPMEPI
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etba�kequiremt+nt.
I Flo jiot Kish to waive #fie 1b' setback requi 'arnent.
_„ :`.�.,.:.�... ::• ort-`(Adjj+cetit Property ow Into ). ,
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