Carroll, Angela (2)

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
New '!Modification ❑'Complete Reissue ❑1Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
'M
A
Previous permit #
Date previous permit issued
Rules attached.
B C D
Applicant Name_"
I #
r-'- f P—_--
Project Location: County
" `� I 24 ki ` �' '-
Street Address/ State Road/ Lot #(s)
Address
'.
State C ZIP
City -'11
7/7E-Mail "`
t
Subdivision n
Phone # —
Authorized Agent
t h M
� '0, 111 ° 1
City �b i�` t' f�
a
ZIP
CW
❑ EW ❑PTA .OPTS
Phone # (_ ) _
River Basin 'Ilh
Affected , OEA
..�&ES
❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body_
_ - nat /man /unkn
AEC(s):
- _ _ _
PWS:
Closest Maj. Wtr. Body_
- - ----- -
ORW: vac / no
PNA Yes / no
Type of Project/ Activity
(Scale: t' )
Pier (dock) length
Fixed Platform(s) ;
Floating Platform(s)
Fingerpier(s)_ _._.-. ._. - --�----.....-.. -- --- ......-.-.. _ i ..-.._ .-.... _¢...- - ....._. _.. - __.._ ..__ _...
Groin length
i
number
Bulkhead/ Riprap length f - !�
avg distance offshore a
Il
max distance offshore
, i I
Basin, channel
..-......-.
cubic yards_ t 4
Boat ramp
' 7
Boathouse/ Boatlift
— _ , a
Beach Bulldozing_ f'... �. t
Other i !
+
' I
I
I
Shoreline Length`'
SAV: not sure yes no @ F
Moratorium: n/a yes no
Y.
Photos: yes no
i
Waiver Attached: yes no
b
A building permit may be required by: oil [ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
or Applicant Printed Name
Signature Please read compliance statement on back of permit*
Application Fee(s) Check #
Permit Officer's�Pr�inted�Name
Signatu
Issuing Date Expiration 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/ I-888-4RCOAST
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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
ANGELA CARROLL
Name of Property Owner Requesting Permit:
Mailing Address: 2624 FAIRVIEW ROAD
RALEIGH, NC 27W8
Phone Number: 919-917-ON7
Email Address:
I certify that I have authorized DENNIS $ SONS MARINE CONST. LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining ail CAMA permits
necessary for the following proposed development:
INSTALLATION OF APP. 12' OF BULKHEAD
at my property located at 184 OAKLEAF DRIVE PINE KNOLL SHORES, NC
in CARTERET County.
I furthennore 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_
1 Signature
Print or Type Name
if ih,e
Title
�l ;- 7 1 i
Date
This certification is valid through n_/ 31 / 2018

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ANGELACARROLL s
(Name of Property Owner)
property located at
184 OAKLEAF DRIVE
on BOGUE SOUND
(Waterbody)
(Address, Lot, Block, Road, etc.)
In PINE KNOLL SHORES/CARTERET
(City/Town and/or County)
, N.C.
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)
" IIJSrt"1�L[,PtTI O N v F � U.LF�Nb��
r�ic:��RKLwtnly Pi -TT -ACHED
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 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
ANGELA CARROLL
Print or Type Name
2624 FAIRVIEW DRIVE
Mailing Address
RALEIGH, NC 27608
City/State/Zip
919-917-0087
Telephone Number/email address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Signature *
MAXINE MILLER ll�elliQ`j/J(. Q/ rn,GQiG,{�jC/
Print or Type Name
275 MILLER HILL ROAD
Mailing Address
N , 2-72(pS
City/State/Zip
Telephone Number / email address
'�-
Date *
(Revised Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Art& t✓ L N 0:R R Ro L L-
Address of Property: i b �A O R V- LE R C' PINE 1 46 LL S E �c�ES , N �� CYk-2TECEr
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Ju,��v-�-iPO,,k Mailing Address: tUc� SeAHDese DV-.
Agent's phone #: 25z-zg1- 69(,.,-L 3�r�+-E��cn, +JC-
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawin the development
they are proposing.
✓ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp://www.nccoastalmana-gement.netlweblcmlstaff-listin or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
J I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
RN �I>✓(1 Q-6 9.2c Li.,
Print or Type Name
4=fk-kV-\AE ,u "DIP W
Mailing Address
4R,f-NtF-c a t}- , N L a -,I
City/State/Zip
ei19-C1cl-C>C,
Telephone Number/Email Address
Date
(Riparian Property Owner Information)
/3
S' ature
Print or Type Name
_1a 1)ak11,e0C Dhye-
Mailing Address
zo
City/State2ip
Telephone Number/Email Address
08
Date
(Revised Aug. 2014)