Llewellyn, James

Z
�I CAMA / '❑ DREDGE & FILL N2 70993 A B C D
GENERAL PERMIT Previous permit#
'New ❑Modification El Complete Reissue ❑Partial Reissue c °• 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 15A NCAC
Fj Rules attached.
Applicant Name — ��; Project Location: County
Address Street Address/ State Road/ Lot #(s)
1
City _ State _ ZIP
Phone # ( ) E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ] PTA ❑ ES ❑ PTS
AEC(:): ElOEA ❑ HHF ❑ IH ElUBA ❑ N/A
❑ PWS:
ORW: Yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) .���
Floating Platform(:) ' '
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 ,
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes 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"
Application Fee(s) Check#
Subdivision - —
City };( ZIP
Phone # (^) > River Basin
Adj. Wtr. Body ""i 5 (nat /roan; /unkn)
Closest Maj. Wtr. Body
(Scale: _ )
❑ See note on back regarding River Basin rules.
{
P�
Permit Officer's Printed Nam
Signature
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 I) 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/ 1-888ARCOAST
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: JP�M�S
Mailing Address:
An -
Phone Number:
Email Address:
.a-fe")
9- L Z
I certify that I have authorized iLe� V <-'t , 1 �4 ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: v G ID o Lk_
�9 a )�> L2A L, 6 V -
at my property located at 9 1 S ,5 a v".) Dy V
in t C I" County.
I VC
1 furthermore certify that I 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:
14-6
Signature
�cf s 1>. L. L e .N
Print or Type Name C .1
Title
Date
61
This certification is valid through 6 Iy30 1 v20 ` B RECEIVED
MAR 0 8 2018
®CM- MH® CITY

DIVISION Of COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOT*VATIONJWaFYER FORK
Nam of Property owner:-
Adcfre�z of PrLjjerty: '--�+-:c�,,vJ .�� 4 t/ � 1�• .v c fG C �t
Agent's Name *
Agard3 phone #-
(Lot or St vd #, Street or o_ , � Cot *)
Maifing Address:
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 atted-od d the d eni
they are proposing.- 111111
1 . ' f \ • } s W 1 1. • t / • f • •:. tr f i .+M# \ 4 ♦ t • /=1• #
f'orihawobjecdonstowh&lsbWngptvpo*4Youmustnftyths,DivWMofCoss0filandgement
AX* in wrM70 w/tiih 1.0 dRP ofrec *W of Srts n.odbe-Corrwpw" ce shoufdbe waged W 400
Comm ms Avis., Morehead Cliy, NC, ZW57. DC1 t ntathrys asn also be c lot 868-
280& No,eaponso Isconsldartid ihs san» as no abjoon iifJ+rorlhwr boon rroWod by!lii�rld' iit®if
..,..
WAIVER SECTION
! wd that a pier, dock, mooring pilings, breaWmter, boathouse, lift, or groin must be set
back a minimum distance of 1& from my area of riparian aces unless waived by me. (lf you
wish to waive the setback, You M jW ini -A the appropriate bigk below.)
i do wish to waive the 16 setback requirement _.
l do not wish to waive the 15' setback requiranen#,
(Pyl P. ty Owner I n
�fr
Ptmt or Type Name
1 , C` • �)6 A t✓ L��
WafiVgAdOM
l A4 A 1171 (a"C
AS2-5S1 71
5-741)
Property Owner lnfonnationi
t
i'�r1G\t
or TO mane
(A' UiYlVjvlei • ci.
�i�ng Adr
T�►� Nr�mber
two

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTWMATIONMAIVER FORM
Name of Property Owner t''1 1-- j t �— �'✓
Address of Properly.
(Lot or Strec #, street or Road, & Co+a►tyj
Agents Name # Mfg Address:
Agent's phone #:
hereby certify that I own property adjaoerd to the above referenced property- The individual
applying for this permit has described to me as sham on the attached drawing-Va,develOPMOnt
they are proposing --
I have no objec im to this proposal. I have objections to this
li'yVahaveobjectionsto, wharitbeing YeamastmOg%►8r Dh*ior,ofCoasWManagement
(DcA1 in w abg rrftlirn 16 days of receipt of Wks nofte, .corrwpwdeece should be malted to 400
Cmmw9Ave.,UoraWwdCfty,MC,28vV WMriepAWw*ftwcan aisobecorr at(2M908-
7.808 No raspotese is considaredthe saine as no oibJe fjon riyouhm* beets notMfed by 2!E j _MBfL-
WAi1VER SECTION
i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of W from my wea'of riparian atom unless waived by me. (If you
vdsh to wabm the setback, you must Inial the appropriate bkv* below.)
I do wish to waive the 15 setback requirement. _
I do not wish to waive the 15' setback requkwenL
(Property owner tg#o mmratton)
Signature
(f 1
Print or Type Name
q' i r C � c 1 �; C'_ Z£sS' z
C1Y)SWMAD -
lai3
Telephone Munber
Date
(Adjacent PropertY Owner Infors>ation)
Print or Type Name
.. 4 -L zi:' �. tc ►Za
CriylSlatu 4
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Teleplx)m Number
Date
Revised 08202
MAR 0 8 2018
DCM- MHr ""ITY

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