Fritzsche, Brian

C1CAMA / DREDGE & FILL'0 70974 A B C D
GENERAL PERMIT Previous permit#
DNew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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
Rules attached.
I Project Location: County
Applicant Name
AddressStreet Address/ State Road/ Lot #(s)
City Ds"
i ` State' ZIP
Phone # (=)Y r ' �E-Mail Subdivision ` f"
Authorized Agent ie t f rr City ZIP WM
Affected ❑ CW b EW ,.p PTA ❑ ES ❑ PTS Phone # ( ) _ River Basin "rt
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Ad Wtr. Body-- �nat /man /unkn)
AEC(s): I y- j
❑ PWS: r 0� 1 f � ei;-
Closest Maj. Wtr. Body i — V
ORW: yes / no PNA yes / no
Type of Project/ Activity
—— (Scale:_
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number %
Bulkhead/ Riprap length—�
avg distance offshore /
max distance offshore— 1
Basin, channel
cubic yards
Boatramp !
Boathouse/ Boatlift
17
Beach B Idozing
Other
J Shoreline Length.
SAV: not sure yes fio
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: C) r E.
( Note Local Planning jurisdiction) n lY #
Notes/ Special Conditions I i f .f
00,
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
Permit Officer's Printeopame �•' f''
Signatur
r ,
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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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
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

C703) 154d=f -- %s; 3-7
Telephone Number/Email Address
Date
3 M�rz��h z.o 18
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER_ NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
hereby certify that I own property adjacent to
(Name of Property Owner)
property located at 2 % L I c,)
(Address, Lot, Block, Road, etc.) .
(Waterbody) `"�` J (City/Town and/or County)
Agent's Name #: �/" S Mailing Address:
Agents phone #: 2 C-L L-' '7 G- C`7 2
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 description below or attach a site drawing)
F
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 nccoastaimana_qement.net/web/cm/staff-listin_q orby calling i-888-4RCOAST
No response is considered the same as no objection if you have been notified by Certified Mail.
1� a .
+i'fi�
(Riparian Property Owner Information)
Signature
Print or Type Name Type Na e
e— t)Ac1F—
Mailing Address. Mailing Address
City/State/Zip City/State/Zip
Telephone Number/Email Address
Date
(Revised: Aug. 2014)

Name of Property Owner Requesting Permit:
Mailing Address: '-L / L- " u �� �'r_ h R.
Phone Number:
Email Address:
I certify that I have authorized f a. %l/ � .S 4-- C--/l 17—
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMAA permits
necessary fort following proposed development:
� f
at my property located at
in County.
1 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.
Prope Owner Information:
Signature
r
Print or Type Name
Title
Date
This certification is valid through l� I