Bam, Robert

CAMA / '❑ DREDGE & FILL No 72042 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 t to 15A NCAC j . /
Commission in an area of environmental concern pursuant and the Coastal Resources ules attachedF
Applicant Name —
Project Location: County1
Street Address/ State Road/ Lot #(s)
Address
- 5f
City_ State ZIP i`
Phone # (" j--" "" "" E-Mail
Authorized Agent _ _
Affected © CW [I EW ❑ PTA ❑ ES ❑ PTS
AEC(s): LiOEA ElHHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
nRW vas / no PNA Yes / no
Type of Project/ Activity
Pier (dock) length
F t e
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) v
Groin length —
number
Bulkhead/ Riprap length^--
avg distance offshore'
max distance offshore
Basin, channel`"~ --
cubic yards - ~-
Boat ramp
Beach Bulldozing
Other__
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes fJno -
Photos: yes no
i
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
C d't'
Notes/ Specia on i ions
Agent or Applicant Printed Name
Signature *'t Please read compliance statement on back of permit r
Application Fee(s) Check #
Subdivision
City ZIP 1 /
Phone # ( _) -"'"" River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale:
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature p j
Issuing Date Expiration bate F'

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 I_ 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

'[,A. AiVIA / 1-1DREDGE & FILL N2 72042 #
A B C ^' D
pENERAL PERMIT Previous permit
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous ermit issued
1 1
As authorized by the State of North Carolina, Department of Environmental Quality �, j
and the Coastal Resoyr` s Commission in an area of environmental concern pursuant to I SA NCAC
I , les attache&
Applicant ame Project Location: County+
1 Street Address/ State Road/ Lqt #(s)
Address, ) _
City'. VJ` State i= i ,i ZIP
Phone # E-Mail
Authorized Agent
W
Affected ti� W �A El ES ElPTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ElUSA ❑ N/A
❑ PW�cS:
ORW: yes / jnb ,f PNA yes / ()
Subdivision r
city A1 % W a
Phone # River
Adj. Wtr. Body f t R -
Closest Maj. Wtr. Body
ZIP
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Agent,6r Applicant Ponted Name
Signattfr* P read compliance statement on back of permit
Applicat& Feels) Check #
IN
Perm' Nficee,s F�n'nt ` me
Signaturet;'
Issuing Date Expiration a e

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _��� �� ` 0�_6
Mailing Address: i, i _,� ��� j 4 1 -
Phone Number:
Email Address:
I certify that I have authorized
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to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
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necessary for the following proposed development: p'
at my property located at
inCounty.
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:
I- Signature
Print or Type Name
`. Title
Date
This certification is valid through
RECEIVED
NOV 15 2017
DCM- MHD CITY
C
NOV 14 2017
DCM- MHD CITY

N6 0717, 04Vp C+d+o Ciroolo 2522220032 p.1
&DJADEW RIPARIAN PROPERTY 2MER STATEMENT
I hereby certify that I own property adjacent to R012LI� �
r I , fNao* of Prwerty 0
property located at,r
on auL
(Gity[rown and/or
>s
N.C.
The applicant has described to me.. as shown below, the development proposed at the above
I ion.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMBfT
i
r �
NW 15 2017
WAIVERSEC110N DCM® MHD CITY
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 hank below.)
X.I do wish to waive the 15' setback requirement.
I do not wish W waive the 15' setback requirement.
Tetap rl email address
V
N
Date
(Adjacent Property Owner Intornnartion)
Telephone Numberlemar7 address
tca -40. 17
Damn*
(r7evised Attg, 2014)
'VaIki for one calendar year after signature`

12x16 of
COVERED
PLATFORM
//—ACCESSORY
/ SIDE LIFT
(SMALL
SKIFF)
ROGUE SOUND
ENO BOATS
RECREATIONAL
WATERCRAFT,OR
ACCESSORIES
TO BE
MOORED ON
EAST SIDE
OF
PROPOSED
DOCK
SITE PLAN NOTES
1. All dimensions are taken at 90" unless noted otherwise.
2. Contractor shall verify property lines and setbacks prior to any construction. JAY
HORTON DESIGNS IS NOT RESPONSIBLE FOR VERIFICATION
3. Contractor shall dispose of existing material per North Carolina regulations.
4. Contractor shall ensure that all structures spanning sea grass are a minimum of
3' above grade.
5. Contractor shall notify landscape architect if any discrepancies occur prior to any
construction.
6. Jay Horton Designs is not responsible for contractors construction practices.
7. All work performed by contractor shall be in compliance with all local and state
building codes and ordinances.
8. Contractor shall obtain all necessary building permits prior to starting
construction.
ROGUE SOUND
RECEIVE®
NOV 15 2017
DCM- MHD VI ■ Y
(NOT TO SCALE AT THIS SHEET SIZE)
;2 y:
3 ism
'�S JilHdit��P�
NOT APPROVED FOR
CONSTRUCTION UNLESS SIGNED
BY LANDSCAPE ARCHITECT
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ISSUED FOR.
REVIEW
ISSUED DATE.
09-01-17
REVISIONS'.
DRAWING TIT
DOCK
PERMIT
JH
DRAWNBYCHECKED
N
BY
W 0
;KALE: 1-20'
SHEET NUMBER'.

I hereby certify that I own property adjacent to _
I
property located atO
(Address,
on j Okvt,,�Oin_
(Waterbody)
I
4A� (
ck, oad, f%
i� , ) _, N.C.
(City/Town and/or Cou )
The ap icant has described to me, as shown below, the development proposed at. the above
to f
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
I V E D
NOV 15 2017
WAIVER SECTION DC M- M H D CITY
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
i must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If y to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property
owner inrormation)
G�
3�0
Telephone Number/email address Telephone umb r/email address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

K
5'_0" 77•-6" 5'_0" t8•_1
12x24
BOAT
LIFT
1206 0'
COVERED
PLATFORM
ACCESSOI
SIDE LIFT
(SMALL
SKIFF)
BOGLE SOUND
—NO BOATS
RECREATIONAL
WATERCRAFT,OR
ACCESSORIES
TO BE
MOORED ON
EAST SIDE
OF
PROPOSED
DOCK
FTS
STRUCTUGER
TO
ONSTRUCTD 3'
E GROUNDWHERE
ANS SEA ASS
: USTE
_ 200FT2
ABOVE
RM
NHW
-;
RENOVATE
EXISTING
BULKHEAD
IN PLACE
7
J
5
'
SITE PLAN NOTES
1. All dimensions are taken at 90° unless noted otherwise.
2. Contractor shall verify property lines and setbacks prior to any construction. ]AY
HORTON DESIGNS IS NOT RESPONSIBLE FOR VERIFICATION
3. Contractor shall dispose of existing material per North Carolina regulations.
a. Contractor shall ensure that all structures spanning sea grass are a minimum of
3' above grade.
5. Contractor shall notify landscape architect if any discrepancies occur prior to any
construction.
6. ]ay Horton Designs is not responsible for contractors construction practices.
7. All work performed by contractor shall be in compliance with all local and state
building codes and ordinances.
8. Contractor shall obtain all necessary building permits prior to starting
_.construction.
BOGLE SOUND
NOV 15 Z017
�oPoH " �y
• 1538
NOT APPROVED FOR
CONSTRUCTION UNLESS SIGNED
BY LANDSCAPE ARCHITECT
N i
M
W
Z OD
�W�
U Z
W =W
Mr
W
N �
ISSUED FOR
REVIEW
ISSUED DATE.
09-01-17
REVISION5'.
NO. ITEM DATE
t
3
5
6
DRAWING TITLE
(DOCK
I PERMIT
(NOT TO SCALE AT THIS SHEET SIZE)
G l I
DRAWN BY JH
Or aCHECKED By]
i
11 SHEETNUMBER'
SCAIE: I— 20'
losuec.r. ma.. u�..t
i