Hidden Harbor POA C/o Rodney Alexander

i CAMA / DREDGE & FILL No 70969 A B C
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
Rules attached.
Applicant Name Project Location: County
±} I
Address '? t'` l %: �. Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( _) - E-Mail Subdivision
Authorized Agent / % I k �` - City { ZIP
Affected f 'CW JEW LJPTA El ES ❑PTS Phone # _ River Basin
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body
PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
V
(nat /man /unkn
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 i
Basin, channel
cubic yards
Boat ramp
Boathouse/ Ptoatlift
Beach Bulldozing
jtn
Other �
Shoreline Length . - AZ
SAV: not sure yes no
Moratorium: n/a yes Kno
Photos: yes } ' no -
Waiver Attached: yes + no '•
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
a � i
Agent or Applicant Printed Name
Signature Please reed compliance statement on back of permit"
Application Fee(s)
Check #
[ _r,•'"} ` See note on back regarding River Basin rules.
t
T 7 '
f. r
Permit Officer's Pria
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/ 1-888ARCOAST
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)
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)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit:
Mailing address:
Telephone Number: 7 d(A ��`y 9IL n
I certify that I have authorized (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of ca )0 ti AC=' L \' . to � �
This certification is valid through l (date).
(Property Owner Information)
Siignature
l
Prirf or TypeName'V2�' WAIAh—
Title, co. owner or trustee for property
Date
Telephone Number
"LA10Ctk@_)WLZ u \L I.,
Email Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �,4z-C 's
,Name of Property Owner)
property located at i0Z)0,N 4VA)f&) e &A,,,)E Z-�l q SL/ P 3
SAND +-10-95 ef41=e )::Z " (Address, Lot, Block, Road, etc.)
on in ln-=AO-PCi` 630 J it , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Io
��- I have no objection to this proposal.
I 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)
'Frzt-�' I2'X yZ'(-� 5wP-i
';7tj4l,�o �o 9 t✓ WI r i Z-! fl
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,jq 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.
( operty Owner Information)
(Adjacent Pr Owner Info tion)
-zr
ature
Sign
Print or The Name
Print or Type Name a
Mailing Address
Mai r > Address�� 2
D
City/St te2ip ,
�
City/Staten- ,
Z, S "v
Tel p o umber
Telephone lVpmpqt
D e
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
�Ltz-C T' r-d'Ci 5 15r7'bc-K
I
,Name of Property Owner)
property located at 1/6 4-1l0aC:;N 4A)e&e Lit SLl P 3
SAN�� 4-10,;,$ (Address, Lot, Block, Road, etc.)
on 10'�DAOI�e, ine*4��; , N.C.
(Waterbody) (City/Town and/or County)
Th applicant has described to me, as shown below, the development proposed at the above
(/ 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)
'?4
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
wi 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.
Owner Information)
'gature M SNEC) -
ikpafw
Print or a Name Print o T
ailing dd
%ZState101Y
Teleph ne Number
rW
V\C
Mn Addr ss
City/S teaip (-A ` C,� C.
Telephone,A(�u�bn `•
Date e
(Revised 611812012)

ACENT RI_PARI,
I hereby certify that I own propert�adjacent tc
a33 SA C �VvS5
OWNER STATEMENT
a AL.#-)(.NNp-�9.
ame of Property Owner
property located at- ' d IL 4k;1[ 1 lit
(Address, Lot, Block, Road, etc.)
on e 2.eVe A� in /3 A�'. !'. R- i' , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
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)
S �o 0 0U l
Pj J
Fin
WAIVER SECTION
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)
Print or Type Nafne
(Adjacent Prope Owner Infor tion)
Print or Type Nam '2 /'� c7�=>- , (4 y
Mail�iddressy-',2
City/State/Zi,
Telephone lyuT4er
Date
(Revised 611812012)

N PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to S
N„v ��04ame of Property Owner
l a
property located at �T! , . - = 4'e h" z
(Address, Lot, Block, Road, etc.)
on A 9/3 C f—e v- in /3e AU T� �'[ - - , N.C.
(Waterbody) (City/Town and/or County)
The app)'cant has described to me, as shown below, the development proposed at the above
locatiotf.
I have no objection to this proposal.
I 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)
13') (,>` il' >,
goc7-r 3'L, p s
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 wme the setback, you must initial the appropriate DianK aeiow.)
�I,r�o wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
perty Owner Information (Ad0* Pro9",P b0Pnformation)
Print or Toe Name
or
T/k
g ° ddress
k '�7-
CitylState/Zip
Telephone Num er
Date
(Revised 611812012)