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ECAMA / ❑ DREDGE & FILL N2 70963 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
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
j 0 Rules attached.
Applicant Namur I t r err--- Project Location: County C
Address_ "'ct ` Street Address/ State Road/ Lot #(s)-
City _ State ZIP
Phone # ()_
E-Mail
Authorized Agent
_
❑ CW
❑ EW — PTA ❑ ES ❑ PTS
Affected
ElOEA
❑ HHF C lH ❑ UBA ElN/A
AEC(s):
❑ PWS:
ORW: yes / no
PNA yes / no
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
Subdivision
City ZIP
C'
Phone # ( ) River Basi^
r
Adj. Wtr. Body n„atsnan /unkn)
1
Closest Maj. Wtr. Body
Shoreline Length
SAV: not sure yes n
J7�
Moratorium: n/a yes no
Photos: yes# no
Waiver Attached: yes ` no
A building permit may be rIequired by: 1 i C..0 C?
( Note Local Planning jurisdiction)
Notes/ Special Conditions_ f9!7,'./
Agent or Applicant Printed Name
Signature P I ease read com pl iance statement on back of permit
7A 1
Application Fee(s)
Check #
(Scale:
ACME
See note on back regarding River Basin rules
Permit Officer's Printed.,Neme
s
Issuing Date
Date
1
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/ 1-888ARCOAST
Fax: 252-247-3330
(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:252-264-3723
(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: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 9 10-395-3964
(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: Jo✓eS 46vzw Ac
Mailing Address: `j(o` Ga(e_ Coee/c_ P,.W
Phone Number:
✓ (- Z�si S
2 2-&,Is-S:700
Email Address: 4.1;eI @;o'�)1sIre 0cfc(US cAn�
1
1 certify that I have authorized 24`�' C C "{�1
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in
County.
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:
Signature
b&n1f't Hr'V1 W CJC
Print or Type Name
—� Title
:_/ 20 / / 9
Date
This certification is valid through 3 t, 20 / ) q
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at����
(Address, Lot, Blo ,Road, etc.) .
' o h N.C.
on ��c��� 5tc�f C��� � � �?���9 , in r9-� /i"Gv
(Waterbody) Rv (CitylTown and/or County)
Agent's Name #: Mailing Address:
Agents phone #:
He/She has described to me as shown below the development he/she is proposing atthat 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)
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 nccoastaimanagement.net(web/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. _
(Property Owner Information) (Riparian Property Owner Information)
Signature - Signature
�ctrVe.\ y-D 0 V1 o vt -P S
Print or Type Name Print or Type Name
q�oq 6-le Creek- road
Mailing Address.
GU�bro At zss IS
City/ atei0p�n'e(@�J✓X',Sis1a"n'�clab•cQr^
Telephone Number/Email Address
Mailing Address _T
City/State/Zip
Telephone Number/Email Address
3-7-0 -- I't
Date Date
(Revised: Aug. 2014)
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to 42 V?
(Name of Property Owner)
property located at-_� c �G j; i�
(Address, Lot, Block, Road, etc.)
on, 0. mac` 40,A;P1 n
lr G �c .�.
(Waterbody) (City/Town and/or County)
Agent's Name #: Mailing Address:
Agent's phone #:
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 fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoaStetmanagement net/web/cm/staff listing or by calling 9-888-4RCOAST.
No response is considered -the same as no objection if you have been notified by Certified Mail.
(Property Owner Information) (Riparian Property Owner Information)
Signature )�, ignature
Print or Type Name Print or Type ame
Li (hn i Gil,
Mailing Address Mailing AdTress
Ccty/State/Zip Cit /Stafe/Zi
cy(gW ��)a.,rS�s lua�(cI�b cd.ti, Y p
Telephone Number/Email Address- Telephone Number/Email Address
3
Date
Date
(Revised: Aug. 2014)