Shew, Michael

CAMA / DREDGE & FILL
"1
GENERAL PERMIT t Previous permit# A B C D
- New Modification Complete Reissue Partial Reissue 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 I SA NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Rgacl/ Lot #(s)
City State ZIP.
Phone #
( ) E-Mail Subdivision j
Authorized Agent _ CityZIP
r 1
❑ CW EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
Affected
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
AEC(s): Adj. Wtr. Body (nat /man /unkn)
❑ PWS: - _ _
Wtr. Body _ a
ORW: yes / no PNA yes / no Closest Maj. I
Type of Project/ Activity
Pier (dock) length'
Fixed Platforn
Floating Platfc
Finger pier(s)
Groin length
number
Bulkhead/ Rip
avg dicta
max dist
Basin, channel
cubic yai
Boat ramp __
Boathouse/ B(
Beach Bulldoz
Other
�r
_r
Shoreline Len;
SAV: ni
Moratorium:
Photos:
Waiver Attach
A building permit may be required by:
( Note Local Planning jurisdiction) --- _„
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "Please read compliance statement onbackofpermit"
(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, 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-411COAST 252-946-6481
Fax: [phone] 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)
http://www.nccoastalmanagement.net/
(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 08/27/ 14

I hereby certify that I own property adjacent to E,4,r As
/( amepot Property Owner)
property located at
on in N.C.
(W�a 7body) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat' .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must roll 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 set
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 blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Telephone Iyumber
Date
� 7S
Ydee!'eAr
M ' ' g Addre
rele�ho�►e u� e�L�� ` ;��cEwED
Date
pp� 2018
(Revised'�I',V012) c,,"

-----------
----------------
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0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ��;� b S� i/y 'V A�, `^ U ` 's
8 of Property Owner}
property located at _
����� (Address t_ �
Block d etc.)
on , in C.., ( -J � / , N.C.
(Waterbody) (City/Town 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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill 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 set
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 blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
J("party„ ner t f matt n)
Sign�¢tune _
Print or Type Name
S4� A,ee free.
Majlaj- Addre ss re
City -I, (� t� tp
TelepPgne,. Number
�2®��__
Date
�acent Prre Owner nformation)
Pint or yp Name
,ee7 ee
Wd ass s ,;f �y `
Ci /Sta e/Z p _ 7`
Telephope,Numbe04112z)�� j
SIECEIVED
Date
(RevhW"4'"$