Kern, David

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CAMA / ❑ DREDGE & FILL No 70996 A B �'� D
GENERAL PERMIT Previous permit#
❑New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality f
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC� ✓ fay l�''
Rules ached.
PP - p Project Location: County
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licant Name r
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❑ Cw SEW M 111TA _ES TS Phone # ( ) RiveX Basin
Affected ❑ ❑ OEA HHF ❑ IH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body NIP1 nat man /unkn
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
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Si atur ** Pleqase read compliance statement on back of permit"
2
Application Fee(s) Check #

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, certifythat 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:')d.y d a o J kal re (( �tf ►il
Mailing Address:
Phone Number:
Email Address:
SO4 -0
C(.t K e-r v1 (P c.-p r RkYJ ► vvq r c c r'h
I certify that I have authorized A-r n d o() -Tr # v ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �D LA i d ► r �✓` t%e%K
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at my property located at ,)- '�> `I «vs.Cl0
in r+U'Z� County.
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1 furthermore certify that 1 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:
ZZA
Signature
Print or Type Name
Title
Date
This certification is valid through
A110 GHW 'U400
810? 91 HV

CERTIFIED MAIL- RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: David and Karen Kern
Address of Property: 239 Rudolph Dr Beaufort NC
(Lot or Street#, Street or Road, City & County)
Agent's Name#: Larry Arnold, Jr Mailing Address: 205 Cottontail Run
Agent's phone#: [phone] Newport, NC 28570
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.
A1 have no objections to this proposal. I have objections to this proposal.
If you have objections to whatisbeingproposed, you m ustnotify 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.nccoastalmanaaement.netlweblcmistaff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified bvCertified Mail.
�.
WAIVER SECTION
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I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
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be set back a minimum distance of 15' from my area of riparian access unless waived by me.
C
_
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
W
446LI do not wish to waive the 15' setback requirement.
Q
(Property Owner Information)
Signature
David B. Kern
Print or Type Name
5518 Country Creek Ct
Mailing Address
Glen Allen, VA 23059
City/State/Zip
804-920-6654
Telephone Number I Email Address
l/ 7
Date
(Riparian pe ner Informa ' )
Signa ure
L
Print or Type Alame
Mailing Address
�nk-co- rlc,.l(� NC_ am�
City/State/Zip
Telephone Number I Email Addre I�'v"" ! N �0�4^
Dam
(Revised Aug. 2014)

I hereby certify that I own property adjacentto David and Karen Kern's
(Name of Property Owner)
property located at 239 Rudolph Dr
(Address, Lot, Block, Road, etc.)
on Newport River I in Beaufort AC.
(Waterbody)
(City/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)
The proposed dock will be built approximately 40 feet from your property line. The walkway of the dock will
be 5 feet wide by approximately 220 feet long. A platform will be constructed at the end of the walkway. The
platform will be approximately 16 feet wide by 24 feet deep. The walkway and platform will be built out of
pressure treated lumber. Approximately half of the platform will be covered by a pergola for shade. A future
boat lift will be installed on the left side of the platform when facing the water from the lot.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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 Info r ation)
7
Signature
David B. Kern
Print or Type Name
5518 Country Creek Ct
Mailing Address
Glen Allen, VA 23059
City/State/Zip
804-920-6654
Telephone Nrberl email address
I17.21/!7
Date
(Adja eertq Owner Informati n)
0
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lgnal ure *
T� LA l� �
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Print or T pe Name
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May, Address
City/State/Zip
25 2 - -7 /0
W
ME
Telephone Number 1 emailaddress
Date
*Valid for one calendar year after signature' (Revised Aug. 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 01--XV4e anj kerri
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
8o Y - qao - �('c? 5- Lf
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Cori
r
W1
at my property located at X 3 I RuAot a rr've' jC6C-r f ! Ct0(
in Cyr+c7 re--i" County.
I furthermore certify that 1 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 N
Print or Type Name
P�ooer�ti/ C'wrn�e r'
—� Title
a ,0217
Date
This certification is valid through /
REIVED
pC{ 26 Z017
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n"rgmplete items 1, 2, and 3.
11i pPrint your name and address op the reverse
so that we can return the card Wyou.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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COMPLETE THIS SECTION ON DELIVERY
5at❑ Agent
❑Addressee
ed e) C. D to of gelivery
j 11 A11�s different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
N I Ililll Jill 11111111 l l ll l 1111111111D
O Adult Signature Registered MaiITM1111111111 3. aervice ryPe rnonry mdn illm � - -
)CM- M H ® CITY
❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted
❑ Certified Mail® Delivery
9590 9402 3402 7227 4091 45 ❑ Certified Mal Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
2 0 6 6 0 _ ❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationT"'
0 17 0 0 0 ❑ Signature Confirmation
4 2 7 0 4 7 7 0 1 Restricted Delivery Restricted Delivery
PS Form 3811, July 2015 PSN 7530-024000-9053 Domestic Return Receipt

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