Carroll, Angela

,--- CAMA / El DREDGE & FILL
GENERAL PERMIT
E'New -- Modification D Complete Reissue ❑Partial Reissue
No 72091 A
Previous permit #
Date previous permit issued
B C D
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an I karea of environmental concern pursuant to 15A NCAC LJ Rules attached,
Applicant Name
Address
City— State ZIP
Phone # O E-Mail
Authorized Agent_
Affected C1 CW ❑ EW — PTA EES El PTS
AEC(s): [] OEA HHF L lH 0 UBA 'Ll N/A
El PWS:
ORW: ves / no PNA yes / no
Project Location: County
Street Address/ State Road/ Lot #(s) I; -, i
Subdivision
City— ZIP
Phone# River Basin
Adj. Wtr. Body (nat /man /unkn
Closest Maj. Wtr. Body
M
F41
No
MR
ME
N ME HIM10
ME mmawwom
J. 00L
Agent or Applicant Printed Name
IS, nature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Printed Name
SignaXure
7
Issuing Date E irati n 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/ 1-888-4RCOAST
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
Name of Property Owner Requesting Permit: QN(AEON CN2-9-oL�L_
Mailing Address: .7 '�p `ZLi irk' IZ v 1 Ew ?J __0A _>
"�lal�ILa11� r��G ' -7(oUrd
Phone Number: 1119 • q 1 _001a`1
Email Address:
certify that I have authorized r7Liy�r so��5 ►� it,. i vr.►sc
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 0' x it u 720_�'L
at my property located at !$�
in C A9725' "T County.
l 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:
Signature
C Li9 CflI�l�OLL
Print or Type Name
Title
1 / /3 / PW
Date
This certification is valid through Q.,S /3_/,-2 1) /A

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: ANGELA CARROLL
Address of Property: 184 OAKLEAF DRIVE PINE KNOLL SHORES CARTERET
(Lot or Street #, Street or Road, City & County)
Agent's Name #: WILLIAM DENNIS Mailing Address: 109 SEAHORSE DRIVE
Agent's phone #: [phone]
BEAUFORT, NC 28516
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 drawing -the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
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 at http •//www nccoastalmana_qement.netlweb/cm/staff-listing 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
ANGELA CARROLL
Print or Type Name
2624 FAIRVIEW ROAD
Mailing Address
RALEIGH, NC 27608
City/State/Zip
919-917-0087
Telephone Number / Email Address
III;
paean Property Owner Information)
Si nature
X4. S#'i1aX.,0557
Print or Type Name
182 OAKLEAF DRIVE
Mailing Address
PINE KNOLL SHORES, NC 28512
City/StatelZip
252- 2-Y-1 - ` 0 3(a
Telephone Number / Email Address
}-14 -17
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: ANGELA CARROLI
Address of Property:
184 OAKLEAF DRIVE PINE KNOLL SHORES CARTERET
(Lot or Street #, Street or Road, City & County)
Agent's Name #: WILLIAM DENNIS
Agent's phone #: [phone]
Mailing Address: 109 SEAHORSE DRIVE
BEAUFORT, NC 28516
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 drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
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-gemeiit.netlweL, cm/staff-listing orby 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 initiM'the appropriate blank below.)
I do wish to waive the 15' setback requirement.
r'
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
ANGELA CARROLL
Print or Type Name
2624 FAIRVIEW ROAD
Mailing Address
RALEIGH, NC 27608
City/State/Zip
919-917-0087
Telephone Number/Email Address
Date
(Riparian Property Owner Information)
Signature
Print or ype Name
275 MILLER HILL ROAD
Mailing Address
HIGH POINT, NC 27265
City/State/Zip
I-fi �h
Telep�ne Number/Email Address
Date
V (Revised Aug. 2014)

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❑CAMA / ❑ DREDGE & FILL NTH '''
GENERAL PERMIT Previ ous permit # A B C D
New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ,icy
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC � /fi �''�c,,�,.%M
T I les attached
' ,
Applicant Name k ? ` x i_ to r � Project Location: County
Address `��_� Street Address/ State Road/ Lot #(s)
City
Phone # ( UD --, Z5 E-Mail er
Authorized Agent rE' ?(fit -;r,fg r f 3 : ,.i ,fit
Affected -0 Cw ; fEW Z PTA _bES A PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /; no PNA yes /*
I
1 II
Agent or Applicant Printed Name
Signature Please read compliance statement on backof permit
CC
Application Fee(s) Check #
City c
Phone # ( )
Adj. Wtr. Body_=
Closest Maj. Wtr. Body
ZIP
_ t I- I
Permit Officer Name
Signature i
Issuing Date Ezpirati n Date