Gauzza, Andy

❑ CAMA / ❑ DREDGE & ML - �T� 70422 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 Resour s Commission in an area of environmental concern pursuant to 15A NCAC
t f ❑Rules attached.
Applicant. " ' ` -
Project Location: County
Address t{ < t.r 'ut v e ' jr) ,,,t Street Address/ State Road/ Lot #(s)
City_r.F S e%� ZIP : t
-} �y
Phone # ( ) i t'r r` E-Mail, Subdivision
Authorized Agent { j r City ZIP
❑ CW DEW
❑ PTA ❑ ES ❑ PTS
Affected
ElOEA ❑ HHF
❑ IH ElUSA ElN/A
AEC(s):
❑ PWS:
ORW: yes / no PNA
yes �t
Type of Project/ Activity
fir, 3
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) �{
Finger pier(s)
Groin length
number
Bulkhead/ RipJIengthavg distamax distBasin, channe
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Phone # O River Basin
Adj. Wtr. Body' •� �� ' ''` i,`—(nat /man /unkn
Closest Maj. Wtr. Body
■■ ■■■■*�11�I�iw1��All�
.. - - - : ■■ �■■.■■■■■mow■■■
lima nzaaw �Wnllli
ME = MEN
■M■■■M'■■■=,1 1M
A building permit may be required by: C,r 4 r't
( Note Local Planning jurisdiction)
a
Notes/ Special Conditions 'c `
Agent or Applicant Printed Name Permit 71),
el
Sign ture ** Please read compliance statement on back of permit Signature
,x
ApplicationFee(s) Check# Issui
Ak Date
(Scale. A.1 )
❑ See note o back regarding River Basin rules.
rinted Name
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/ 1-888-4RCOAST
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)
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

Apr, 11. 2018 11: 45AM No. 3252 P 1
AGENT AUTHORIZATION_ FOR CAMA PERMIT APPLICATION
LdU 7
Name of Property Owner Requesting Permit:
Mailing Address: 5 w' Q-
i Y-
Phone Number: g 14 M3 31 7
Email Address:
I certify that I have authorized
4�g nt / 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 �We_rd County.
/ furthermore certify that / 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.
ZOwner Information;
-n Signature
��
Pfid or Type Name
Dwl�e
Title
-1 l r /tk
Date
This certification is valid through I I

AP r, 11, 2018 11: 45 A�OR A PIEFIMOORING PILINGSIBOATLIFTIBOATHOU; N o, 3 2 5 2 P, 2
%
T hereby certify that I own property adjacent to L--)6-i-A ys
(Name of froperty Owner)
property located at
Block, Road,
on �.�� arv��r G "7" , in,�u ��s !too , N.C.
(Waterbody) (Town and or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilingsftadifdbvathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
LZ I do not wish to waive the setback requirement.
I & wish to waive that setback requirement.
DESCRIMON AND/OR DRAWING OF PROPOSED DEvELOP.MEN7:
(To be felled in by individual proposing development)
eptas .
P low
Pp-o,pog--d (4&Y
Svde�
L
Signature
SU ale
Print or Type Name
yy o—So,p- 7 P / 9
Telephone Number
Date: Ll If

Ap r. 11. 2018 11: 45AN OR A PIER/MOORING PILINGS/BOATLIFT/BOATHOU.No, 3252 P. 3
.h hereby certify that I own property adjacent to 's
(Name o Property Owner)
property located at
(Lot, Block, Road, dtc.).
on A A OK P CUT in NC
(Waterbody) (Town and/or Coun )
He has described to me, as shown below, the development he is proposing at that location,
arid, I have no objections to his proposal. I understand that a pier/mooring
pilings/boadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I I Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPN EINT:
(To be filled in by individual proposing development)
�A
PIZ9. "g_j
-t-u C3..Q
J- t rPI16 La f 7P
]VAT]St . i1
Print or Type Name
Telephone Number
Date:.~g��