Madden, Carol (2)

IN/
5
❑CAMA / ❑ DREDGE & FILL N2 70909 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 Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name 1 Project Location: County
Address i _ ` ' vim t a Street Address/ State Road/ Lot #(s)
City
Phone #
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
❑ PWS:
State , ZIP
— Ut E-Mail
❑ EW 'N TA ❑ ES ❑ PTS
❑ HHF d IH ❑ UBA ❑ N/A
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 Bulldozink--
Other
cf
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
Subdivision
F
City 1, ZIP_ —
j�
Phone # River Basin _
Adj. Wtr. Body nat man /unkn
Closest Maj. Wtr. Body
(Scale:: )
A building permit may be required by: ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name,
Signature "Please read compliance statement on back o ermit **
V
Application Fee(s) Check #
Permit Officer's Printed Name
Signature l fir'
Issuing bate 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/ I-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

A41
VCNENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date 1 a �( - 0I7
Applicant Name �� rd / %,� doe e �
Mailing Address / Z % / a , r i�=i
I certify that I have authorized (agent)
�r ; c C//&
John E. Skvarla, III
Secretary
- 0VED
JA N 2 2 2018
DCM- ►4HD CITY
to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
,(i 1lc
at (location)
/ sib Jir
This certification is valid thru (date) _ I '; - a � — r
Signature —4/1
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity l Affirmative Action Employer
Nidy,W[V
NorthCarolina

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
's
(Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on �� r-4 % ` - , in f-�- t' , N.C.
(Water ody) — ' (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I , t'
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)
�Acj ,5°,'S S4re,'J 4,-f-
��- -Cr. rt or < t�
f f r"'r E ,—,y
/ I r 51.
t /JAddCr)
P r. 61 c r-+"Y
WAIVER SECTION � 14N
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groigi Prid4lbe set
back a minimum distance of 15' from my area of riparian access unle waived by me. (If you
wish to waive the setback, you must initial the appropriate blank belovv°I�i`° iv�p-'
I do wish to waive the 15' setback requirement.
not wish to waive the 15' setback requirement.
(Property Owner Information)
Signet re
�r
Print or Type Name
Ig5ia CA 2,/, (�4
Mng Address /
M� �
r ,)i< V14
City/ tatelZip
I q ') q 41
Telephone Number
Date
(Adjacent Property Owner Inform ion)
Si'(/'//i�Jat/jj(j e
Print or Type dame
Mailing Ad ess ,
(` i State/Zi
Telephone Nuber
1:�2 -I (�, ;-j n l '��?
(Revised 611812012)

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❑LAMA / ❑ DREDGE & FILL lid 70909 A B leD
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 irl an area of; environmental concern pursuant to 15A NCAC
0 ''t ,.. 1❑ Rules atta i ICounty,,_ i fi
Applicant game � M - ;; t - Pro 'ect Location:
Addres$ T '` ` (
."� v ^ Street Address/ State Road/ Lot # s
12 City, Statek,,,ZIP �' _�j (`;' ►
Phone # E-Mail Subdivis' n
Authorized Agent
r --
Affected P,CW ENW A ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF IH ElU13A ❑ N/A
❑ PWS:,
ORW: yes / no PNA yes / ,no
Phone # -,Ut_.Vx River Basin'
Adj. Wtr. Body
Closest Maj. Wtr. Body
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Application Fee(s)