Leach, Bryan

41,
JCAMP. / DREDGE & FILL
GENERAL PERMIT Previous permit # A B C D
_New ❑Modification ❑Complete Reissue ❑Partial Reissues, Date previous permit issued
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
D Rules attached.
Applicant Name Project Location: County
AddressStreet Address/ State Road/ Lot #(s)
City t .A i State 4��'-ZIP—
Phone # ( )-Mail "--'' Subdivision
Authorized Agent ; %; ) s {' . { .[,., s-City I K ZIP ? .
❑ CW -Q, EW q PTA ❑ ES ❑ PTS Phone # ( River Basin
Affected ❑ OEA ❑ HHP ❑ IH ❑ UBA ❑ N/A �
AEC(s): Adj. Wtr. Body ,�.. nat n /unkn
❑ PWS: �
Closest Maj. Wtr. Body, w. ` ' ' r
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 N4 f
Shoreline Length "r
SAV: not sure
Moratorium: n/a
Photos:
Waiver Attached:
j
yes
yes
yes
yes
!�
no
no
no
no
A building permit may be required by
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
r
(Scale: )
_." ❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature
Application Fee(s) Check # 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
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888-4RCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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.nccoastalmanagement.net/
Revised 08/27/ 14

r
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Yujn-n '1
Mailing Address:
Phone Number: LN %
Email Address:
I certify that I have authorized , ;iRoryv' "Lfz
Agent % Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: rf— s f <=,
at m property located atj�a-
in LL County.
I furthermore certry that 1 am authorized to grant and do in fact grant permission tc
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.
Information:
r"
fs-
"�--� arynzrtwe
'Tint or Type Name
Title
Date
This certi ication is valid through 9

ADJAQF_i '.:APAR'lM
r„p GdiaCa..'Ii YO
prcperry ivCated at �a a ear Proz
er e
(Address, LWL, 811ACK Road sta.)
(Cfty, Town andlor Court;
f j.�p [p�w�p�{ has
described
y. ^ 5�p �j � �p n j,� yy�p� asp w�tlq{ py� np
231y.}.� iVQIiC i34J t3��l�ri4J i�t y Zii4, as s 2oW F i.IeI:J!'7: (5(� dGVGI��lli�lli preip.a1 at :li- (.7'byv¢
l'✓ y 1 have no obiLctioll to Lt lis D VLVS 1
C�r� a.�`t'__v,•i Lr»aw �dc _.'„t,,_' a�.4 :fF his i-0 ;
:a�Ea33iiifi �? 3t?�n's �6bC- Ea'9T�s2 j
i understand yy, that a pier, doc mood ;c=fi��nS, boat rant , i;reaie afar. b4ain0usE: 1: ;
t iSi >JE e0t NGic i FlI?ftITi2ii CJIS irw vt ;� tiC ist1� 3ri'?. 0� fFvaii3i� aC:' t
You wish io weive the sei�a�Ec; ; o� ..:,�1- �,. ct iyrbt„
.sus' .M;Nal :he approp: ate vfar bA unless Waived by
_fo,v.l
-------- ,1 co vista to hive the 15, setbac; require] -,err.
i
I i ego not wish tO waive the 15, setbe.vk reg4=irer^ent
Print or Type Name
Nlaff, Addres
—
�-
Telephone Mumberl email address
!M
_Valid for or,ei2 dar :;f83r 2itCr Sf�itatUrE
��orlmafion)
L
ZZ;'
7elephone/ltunVertemay address
(ReV sad Aug. 20?4)

Page 1 of 2
ADJACENT RIPARIAN PROPERTY OWNER STAJE_. T
I hereby certify that I own property adjacent to jj--r'jb� c'- 4wn---
(Dame of Prop fY
property located at vS rno\ t -c.,---,
(Address, Lot, Clock, Road, etc.) N,C.
onCry_ in rx �'
` �VVaterlocly) (CitylTowr! 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 ANWOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be si
back a minimum distance of 15' from my area of riparian access unless waived by me. (if yc
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.
file:///C:/Users/Kim/Documents/831 3/14/2018

1'aue 2 ol' 2
IP-r erty Owner l!lLarmatiop) (Adjacent Property Owner Information)
lure
Print or Tyne Name
:�,, `'\� Ur
U t rr
Mailing Address
vgitXlJtUtf.+ Lip
-d0 yr VS: r
Telop4ione Nuinbe� r
/?ttlrc
,f
Sit1{dFI
Print or TiVanae
Mailing Address
City/Staf p
Telephone Number
(Revised 6118 4
file:///C:/Users/Kim/Documents/831 3/14/2018