Mishoe, Michael

-1CAMA / -_—i DREDGE & FILL
GENERAL
PERMIT
ew ❑Modification ❑Complete Reissue ❑Partial Reissue
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As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
s
Applicant Name
Address
City_ State ZIP
Phone # ( l E-Mail
r
Authorized Agent
Affected ❑ CW AD
TA ❑ ES ❑ PTS
AEC(s): ❑ OEAHF IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
A B C D
Previous permit #
Date previous permit issued
Project Location: County
Street Address/ State Road/ Lot #(s)
❑ Rules attached.
Subdivision
City b:'�' ZIP
Phone # ( r i River Basin
Adj. Wtr. Body (nat man /unkn
Closest Maj. Wtr. Body`:
Permit Officer's Printed Name
Signature
Issu n Date Expiration Cfate ._

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 howto complywith 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
1367 U.S. 17 South
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://www.nccoastaimanagement.net/
Revised 08/27/ 14

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: R Y1 t,,, t r1j s
Mailing Address: 7�c.a ��� 1r V
Phone Number:
Email Address:
certify that I have authorized M iej--j
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
^F er 4Code- crDj-►
at my property located at 20 ti>C a,"
S
in e t-- County.
I 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.
Property Owner Information:
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Signature
CA
Print or Type Name
Title
Date
This certification is valid through / I I 20
RECEIVED
MAR 13 2018
DCM- MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to
property located at (Name of Property Owner)
�c'. _.,`r_ t . �- . � �.-
(Address, Lot, Block, Road, etc.)
on __ c" _ ` __. in _ _ N.G.
(Waterbody) T— (CitylTown and/or County)
The applicant has described to me, as shown below, the der,eioprnent proposed a, the above
I
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)
t'
5 �fii ,lt "` �` ,. Ali •.� rBti
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin mdRE 1VED
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 blan: telow.)
v MAR 13 2018
cl do wish to waive the 15' setback requirement C� -ry
I do not wish to waive the 15' setback requirement.
DCM' MHD . -
(Property 1Owner Information) (Adjacent Pr perty Owner Information)
SIgnati re Sig'� i�re(
Print or Type Name Print or Type %are� �1 ----
L3L i�.4L.� c
hfar rrg Address A4 ,'ling Address r
City Gtate,Zip t✓ State" ip
Telephone Number Telephore NLMbCr
_
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P-AA.CRNT .IFUPARIAN PAnPFriTv_WNgg STATEM
I hereby certify that I even Pto wrty adjacent to f'i l-LSI C 4
property located at {IVarrre Property Owner)
(, Lot Bites,j( Road, etc.)
on in
(Wate Lfl dy)
(Ci yf 1 iJwn and(o7 Cou
j
(T/�he applicant has described to me, as shown bsiorL law, the developinu3it proposed 'At the eve
I haVe no obJecdion to this proposal.
I have objections to this proposal,
VESCFAR yll AN=R DRAwtN(3 OF iWposgi Divao l
Ond• jrOPM t»uot fill In descrfptlon blow or aft0h 816 dra rrg)
(n\ J,gpi
WAIVER S.T N
i understand that a pier,dodk, mooring pIlir s,. ieakwai 6r, boathouse, lift, or groin must beset
ba,,* a minimum distanw of, 15`: from my area of riparian access unless waived by rile. (If y°oti
'
wish to waive the Setback, you must al the appropriate blank telow.)
RECEIVED
s — i do wish to waive the 15' setback requirement,
MAR 13 2018
I do not wish to waive the 15' setback requirement.
( t an} t (Adjacenty Owner l �� H D, CITY
9' . e
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Signature Signature
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