Jones, Bernice

�. y�CAMA / � DREDGE & FILL
No 70952 A B C D
GENERAL PERMIT
-- Previous permit #
13New -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.
Applicant Name ti.. t `
Project Location: County
s �,�
Address
Street Address/ State Road/ Lot #(s)
City ) State 4F�
Phone # /E-Mail
( �)
Subdivision
Authorized Agent -•�
City ZIP
_
ElCW ❑ EW 4fTA El ES ElPTS
I /
Phone # ( ��)+ 1 � / River Basin
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body^ ( nat/ man /unkn)
❑ PWS
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no
NMI
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Agent of Applicant Printed Name j
Signature Please read compliancesta
Application Fee(s)
it
Check #
Permit Officer's Printed Name
i
Signature 1 ,
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/ 1-888ARCOAST 252-946-6481
Fax: [phone] 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
(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

t`
Styron, Heather M.
From: Bernicejones <[e-mail]>
Sent: Tuesday, February 27, 2018 8:03 AM
To: Styron, Heather M.
Subject: [External] Bernice Jones dredging permit
CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an
attachment to Report Spam. <mai Ito: report. spam ,nc.gov>
Hi Heather, My neighbor took a picture of this form. I can ask him to mail a hard copy. Let me know if this is OK. I
will send you the form from my other neighbor, Marc Smith and the form authorizing Bentley Brooks as my agent later
this morning.
Thanks for your help.
Bernice

.4

Styron, Heather M.
From: Bernice jones <[e-mail]>
Sent: Tuesday, February 27, 2018 11:42 AM
To: Styron, Heather M.
Subject: [External] Bernice Jones dredging permit
CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an
attachment to Report Spam.<maiIto: report. spam ,nc.gov>
Hi Heather, I tried to send this earlier today but can't tell If you received it. Let me know if you need anything
else. Thanks again.
Bernice

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 2 2
Name of Property Owner Applying for Permit:
Z - -
5
Mailing Address:
ZA-
!�G06
I certify that I have authorized (agent)
-- ��-.� G''L'� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
11
ZG
Property Owner Signou"ri Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to ?,W111a -L r -5
(Name of Property Owne
property located at Gu�-IIK4 LA4V .. We vo,914
(Address, Lot, Blo d'Road, etc )
on fir© � Grt , in tt/ctiy.rv7
(Waterbody) (City own and/or Cour
The applicant has described to me, as shown below, the development proposec
location.
— IZ_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEL.OPMEI
(Individual proposing development must fill in description below or attach a
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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)
(Adjacent Property Owner Information)
rV
Signature
Signature
�u G� llfu!/gy, e y
Print or Type Name
Print or Type Name
Mailing Address
Marl* Address
City/statemp,
city/State2rpp
m cG Z76,, 7
Telephone Number
Telephone Number
`f/`/ 389 '63¢7- -
Date
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _!��+• L �__ ��� s
property located at _ d Z mil' (Name of Property Owner
on (Address, Lot, Block, Road. etc.)
(Waterbody) (Ci /Town and/or County)
The applicant has described to me, as shown below the development proposed at the above
location. _
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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings 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 etback. you must initial the appropriate blank below )
V I do verish to waive the 15' setback requirement
I do not wish t"aive the 15' setback requirement
(Property Cl er In or a ' n) (Adjacent Property Owner Information)
Print pr Type Na n Print or T pe Name
ingAd rtss / Mailinyre
CitylA jtev7l Cit /State2ip
TelephoneUm Fr
Teiepholt Numb
Vaie Darr
(Revised 611812012)

-vs,+

1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1
I hereby certify that l own property adjacent to , z;0*4B 6G✓d�� �bS 's
Name of Property Owner)
property located at I
(Address, Lo Block, Road, etc.) $
on ��,A,�'tJnn F in ,N.G. s
(Waterbody) PtOAvn and/or County)
The applicant --has described to me, as shown below, the development proposed at the above
location./
�- 1 have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
�iLv 9Vo i �� �► `� oti�ifYlC�tjJ'aN S �T"
RECEIVED
OCT 21.2015
DCM- MHD.CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)dAC� `$;*•�
I do wish to waive the 15' setback requirement.
MAR 2 3
I do not wis waive the 15' setback requirement.
(Property OwA9r Inf tion) (Adjacent Property Ov+r r Information)
or
M 7i Ad ress
City/St
Telephone Number
Date
Signature
Print or Type Na e
Mai!' g Address
City/Sfa 010p
37-e �S/ - / 0 # C2
Telephone Number
9'- 4-- / <
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent is
// (Name of Property Owner)
property I'ocated at 174 -1-Av1
//-- (Address, Lot lock Road, etc.
on �fZ�G0 Cn .�K� , in � G , N.C.
(Waterbody) ity/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
l have no objection to this proposal.
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)
N-4�'NM" A4NrtJ C L JVrc4 2 o / 4&dt— 744S 'tJ6"(-L
�iJ Jc.c. /V Gi' C% rY 9 er 77/f, R}'/ o c� P.A77oivs ��"✓�
lc��i'Ib�fv ONc. ��
OCT. 21 2015
DC_M- MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15 setback requirement. R Ek� NED
(Property Owner Infor atio) (Adjacen rt 0 n forma 'on)MAR 2 3 2016.
� �' 7r
re
or
0"
M i ing AddressN
ltyis / 'p
Telep one Number
Date
-v
Sig
mvfw
q ►fit. MK �(��/
Print o T Pe N�c
a �
1 S
Mailing Address
Ra i. N6- 2
City/State/Zip
Telep . ne Number
Date
(Revised 6/16l2012)

a
RECEIVED
OCT 2 12015
®CM- MHD CITY
06'
a
3.a
MAR 2 2016
3 <f
2'S '

tic 'AMA / C IPREDGE & FILL N2 t 095 B 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
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC '
_ f - [],Rules attache�j.
Applicant Name_ } '; i ` ,I,," Project Location: County �,,,_ ;, >�'y'- --
Address 1 CF 1 L l - i Street Address/ State Road/ Lot #(s)
City_ i ,A Lt: � Str ,, i' ( io / I ,� �� 1 �.--fie .__._.?� 1, �ji"U` , �;'i ` .l �` _:'•�`�
Phone # l n E-Mail
Authorized Agent
4Lk.,tA4L'
❑ CW
�j EW *4 ❑ ES ❑ PTS
Affected
❑ OEA
❑ HHF ❑ IH ElUBA ❑ N/A
AEC(s):
❑ PWS.
ORW:
yes / no`
PNA yes / 1
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
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?
SAV: not sure yes `no
Moratorium: n/a yes ,rfo'
Photos: yes `{tili--
Waiver Attached: yes Ab
l f�
A building permit may be required by:
r
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent Appli n d ame
Signature ** Please read corn ncesfatemen o ermit*�`
Application Fee(s) Check #
Subdivision
City_ ;A- '\.le' kJ f ZIPS
Phone # (�( ) / / ' River Basin.
'f r
Adj. Wtr. Body Ii J
Closest Maj. Wtr. Body�i�.-lx� t
/
iR
(Scale:' )
❑ See note on back regarding River Basin rules.
Permit0 icer's`Print�dp ame ?
Signature�
Issuing Date Expiration Date