Robinson, Eddie

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�] CAMA / 1:1 DREDGE & FILL Ml A B C D
GENERAL PERMIT Previous permit #
❑flew ElModification [:]Complete Reissue El Partial Reissue Date previous permit issued
7
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_
71 Rules attached.
Applicant Name
Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP 'N21
Phone # (—) E-Mail
Authorized Agent A I
Affected
El Cw \EW ?TA �<ES L1 PTS
N/A
AEC(s): El OEA El HHF El lH D UBA El
El PWS:
nRW- vas / nn PNA Yes / no
Subdivision
City ;
ZIP
Phone# O River Basin
Adj. Wtr. Body-- (nat /mnn hinkn)
Closest Maj. Wtr. Body
Type Project/ Activity
of
(Scale:
Pier (dock) length
s)
Fixed Platform(s)
s)
Platform(s)
Floating Platform(s)
Finger pie r(s)
Groin length
Aoffshore
number
a length
Bulkhead/ Riprap length
p
avg distance off
offs 0
max distance offshore
Basin, channel
It
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: ❑See note on back regarding River Basin rules.
Note Local Planning jurisdiction)
Notes/ Special Conditions
N Aigent r p1licant Printed 4me
Signature Please read compliance statement on back of permit
Application Fee(s)
Check #
_7L
Permit Officer's Printed Name r—
Signature
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
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: 1: �Co) Q 12-r-,, 6 n Sby�
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
asa - asg--cpyU9
Ca`','e<� l i n t Ul
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: � CA L C \i I n ui I b ut 14
at my property located at VO ;- TC-�.1 Icxs
in Ott r -k County.
I furthermore certify that l 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:
Signature
t OJ A -e )9—v bv� S b-v
Print or Type Name
[)wY)e-
Title
SI 2-
Date
RECEIVED
This certification is valid through MAY 0 2 2018
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that i own property adjacent to -Em Li �� 6� rnSbYL ,s
property located at l�� {Name of Property Owner)
{Address, Lo Block, Roao, etc.)
on `� L �'S �i �,/' in f
(Waterbody) { itylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lo8n
_,I, I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
OndMdual ProP®5in9 deV%menE rcmust ill in descriptiren belorr,r mr arfach a site drayfing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.
�n I do not wish to waive the 15' setback requirement -
(Property Owner information)
,Sign tore
fin h�; nSLM
Pnnt Of yyp e N/ke
M lUpg Address
1411 tg 4e.,,- y l �( �
Ci4f/Stafeh
1p
asy qL,el
Telephone N mb .email address
5 L ije
Date
"Valid for one calendar year after signature*
tAda rop6JV-Owner Information)
Signature*
l
Pnnt or Type Name
C) / Ter is �l
O
ao
Mailing Ad
� �
NU
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Telephone Number.1 ail address
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Date
(Revised Aug_ 2014)

#4*k

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
1
I hereby certify that I own property adjacent to E� �,Ir ,(�- iwn's I s
(Name of Property Owner)
property located at 0 a `7-a�I Jc-Ys Ll i
(Address, Lot, Block, Road, etc.) �,,
on 5�'J'`� , in ��'r=tit�� ►� N.C.
(1Naterbody) (City/Town and/or County)
Agent's Name#: (,,Yn 0,`40u� Mailing Address: I I JJYJ74,Af yip,/ l nIrid �p
Agent's phone #:,-, - 1d 5- 3 a l L� tC�e
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTiON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
0 es
II
r Gam ��•yr.� --, �, W G v P -�I 5
If you have objections to ghat is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htt-*#Www.nccoastaimanag!emant.net/web/cm/staglisting orby calling 1-8884RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail
(Property Owner Information)
Signature
E-mod l�e 1&6 n s u�1
Print or Type Name
ba
Mailing Address
1 V i h kr v► l t-e 51 0
CitylStatelZip
Telephone Numberl Email Address
S lz l�
Date
(Riparian Property Owner Information)
�._
Signature
&Cid )�
Print or Type Name
F
/ 9 a t Rv<,,,p (I
Mailing Address
I�'I NC ��6 (z
CitylState0p
q 117 �I 0 119H a IL'Otd- k6k-4-
Telephone Number/ Email Address
qA ) /ix
Date
(Revised: Aug. 2014)
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