Dupree, John

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CAM,A / DREDGE & FILL 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 Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC Rules attached.
Applicant Name
Address T
City State _:_ZIP
Phone #
Authorized Agent
ElCW
❑ EW ❑ PTA
Affected
❑ OEA
❑ HHF ❑ IH
AEC(s):
❑ PWS:
ORW: Yes / no
PNA yes / no
❑ ES J PTS
❑ UBA N/A
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
�_ � '.`� � � .- ZIP-, —.
Phone # 'River Basin
Adj. Wtr. Body_ (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:~ )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore t
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing `�
Other 1 -
Shoreline Length
SAV: not sure yes o
r
Moratorium: n/a yes o
Photos: yes „p,r
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
f 0 f .`
❑ See note on back regarding River Basin rules.
Signature ** Please read compliance statement on back of permit
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 [)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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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/
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 08/27/14

3
i
t herby cattily that I t proparty adjacent to J 01Z /U 1%
(Name of Pp rtetyy Owner}. .
phq>efty located at U.
;} (Addrass, , Block, Ro , ate)
on ilC,
t t.4 t� 5C tri lf.C.
{Yliaterbody) ( ityrrown andlor Courrty)
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal,
DESCRIPTION AND/OR [DRAWING OF PROPOSED DEVELOPMENT
#Hdtvldual prapostng development must fill in description balaw orattach a sfte drawing)
ns l i -one 10, coo I b b ooL: - L-, -P4- Gt lid adcG ` ayta..f
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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 15frcim—my-area of riparian access unless waived by
me. (if you wish to waive the setback, yodmust Initial t�e appropriate blank below.)
fit'-` i do wish to waive the 15' setback requirement. so'L
i tilt not wish to waive the 15' setback requirement. c'c'-� L
(Property Owner Information) (Adja pent Property Owner Information)
mature" Si ature' (� }
Prim or Type Name PfintlTypsr Name
'64iling ddress c-%�D M 7" g Ad ress a15
t�
City�eoh —� Cit y ,Sfa i 3
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Telephone Numberl email address Tel butte Number / email address
Z1_�/ _���`�
Date Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature`
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I hereby Certify that I evyn property adjacent to - 0 -P r
Na 0 Of Pro owner)
located at --hyd
property (Address, Lot, Blocks Ro d, .1 OtC- N,C.
In
on aterbody� (CltyfTown and/or County)
01111'
The applicant has described to me, as shown below, the development proposed at the above
locatiqr(
I have no objection to this proposal.
I have objections to this proposal.
DESCRIplJON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must Hit In description below or attach a site drawing)
t-,,;,-4- and 6LA,4-icnJ 1�cc-KiA�
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WAIVER SECTION
or
I understand that a pier, dock, mooring pilings, boat ramp breakwater, boathouse, lift, groin
by
must be set back a minimum distance of 15' from my area of riparian access unless waived
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 notwish to waive the 15' setback requirement.
--
(Property Owner Information) (Adjacent Property Q ney nformation)
Signature
Pi,enatu=re
O.0
Print or Type Name
Print or Type Name q e- 1X::� & '3
7 ZZ 3 , Mai!`' g Address
Ua iling dress :070
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cityuv/statf C�'ity�stagt'
Telephone Number I email address
Te
Telephone Number email address t&L11
/I 'E-- / 7 Date*
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'Valid for one calendar year after signature*
(Revised Aug. 2014)
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AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit:
Mailing address:
Telephone Number:
OVA
I certify that I have authorized r SLi-flirel-C 2(agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
/`
necessary for the proposed development of J&t 4.' o--fi J�- L",
at my property located at
�\�s �r � �tiG a
This certification is valid through i;--' Zd 11� (date).
(Property Owner Information)
/ Signature
�o �N � /�
Print or Type Name
C tc) 0 C ,-
Title, co. owner or trustee for property
Ll- Z- /,S-11'
Date
,._ S 1 -3 — 13
Telephone Number
Email Address