Woodall, Tony Chad

-CAMA / ❑DREDGE & FILL
GENERAL PERMIT A
*ew El Modification ❑Complete Reissue El Partial Reissue
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_
Applicant Name
Address J, t
City State' ZIP
Phone # O E-Mail
Authorized Agent J
Affected ❑ CW ❑ EW PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) —
Groin length
t
i Bulkhead iprap length i
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing-'
Other �.
No71304 A
Previous permit #
Date previous permit issued
Rules attached.
Protect Location. County
Street Address/ State Road/ Lot #(s)
B C D
Subdivision
City ZIP
Phone # ( Yf ` x River Basin
Adj. Wtr. Body __ (nat /man /unkn)
Closest Maj. Wtr. Body _
Shoreline Length 771/7
(
SAV: not sure yes 1
Wool
Moratorium: n/a yes rho , {y "
_. ...... - — - .-..._....-..._.. t -- _..
Photos: yes 116 I
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction) ! f
Notes/ Special Conditions
i
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
F f
Permit Officer's Printed Name
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, 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 how to comply with 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/ 1-888ARCOAST 252-946-6481
Fax: [phone] 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)
(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/I7

0
CERTIFIEQ MAIL • RETURN RECEIPT REQUEST99
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property owner.
Address of Property: - '
{Lot or Street #, Street or Road, City & County)
Agent's Name* -4 Ll Mailing Address: ---
Agent's phone #:
j
l hereby certify that l own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing -the development
they are proposing. tion or n wit i
mensione-
I/ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what 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 hU2 tl ww nccoasrairrranacremer „A�n.. brcmistaff list/no or by calling 1-8884RCOAST.
No M!ganso is considered the same as no objection if You have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 In i I the appropriate blank below.)
l do wish to waive the 15' setback requirement.
V i I do not wish to waive the 15' setback requirement_
(property Owner Information)
Signature
Printa Type Name
- V�ee4crd�
Marling Address
C)�+Loci
cityJ3tat `p
(Riparian Property 707m
nation)
Signature
Print or Type Name
Mailing Address
cityJStgt&DO
i CW€1�do l (+t Call�rc��iCS�3ti(
Telephone NumberJEmail Address Car
Telephone Number) Email Address
D�
(Revised Aug. 2014)

I hereby certify that I own property adjacent to t. ' � J .nda�f Is
.(Name of Property Owner)
property located at 1 , Of dr t
(Address, lot, Block, Road, etc.)
on TA tt� Cy' t i'l k - in _ i {`t K�( , N.C.
(yyaterbody) (City(Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
._off I have no objection to this proposal.
I have objections to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
{fiKffvfdrrat proposing development must till In desalpf m below or aff Ch a 8#9 dAMng
WAMR SECTIQN
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.
A Do I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Simafure
Telephone Number/ small address
:2 r„loZ��6in ►g,
(Adjacl Property Owner it ration)
-'f va, v
Rhmntvrn
Print or
-b9q-,s3j:-1�
Telephone Nymberl sma# address
.512l //,s3'
LVIev
N
(Revised Aug. 2014)
+4141iii Iry +.ns n.il�.+.{ar t��� �o1F�r �irnitilf r+r�

ADJACBff RIPARM PROPERTY OWNER 2141LWff
1 hereby cerfify that I own property adjacent tD_ TO`--i C�\-Q) �'JIZJQIJC-11�s
P7 Owner)
Prop" located at Fe,
(Address, U* Block,Road. 4ft.)
on in N.C.
(Waterbody) (City/Town and/or County)
The applicant has deserbed to me, as shown below, the development proposed at the above
10I �* � —
4�1 have no objection to this proposal.
A 0 7 * TS. .-T, T 7
aR SECTION
I wularstand that a pier, dock, mooring pilings, boat romp, breakwater, boathouse, ifft, or groin
I do wish to waive the 15! setback requirenumt.
lleol
P-7 -- I do not wish to waive the 15' setback requirement
TSA�Phone Nw*" I &ma# address
b
m?"011 "ArsiWW", WAY
D019"
(Rev**d Aug. 20U)
W10*

DmSION OF t
ADJACENT RIPARIAN PROPERTY OWNER NOTWICAMMAMM FORM
Name of PmPNV• �e e• ► ��at
it
1. ! f. • t*r1i
•.c ter, •� a= : ' • f�c •:L•.iLf • dill
t s • • •�; :• � I(...1 •,i=.Sr1 Lk� xf.�t t�ILI,.L':c.1:� !t- [Y
have no objections t• this proposal.
have objections t• this t • t •h
• r • rl-n- r .• • rr fik • «
I r 'r • J _ r . a �
i •
•::fftitl fi-t St. i`i� .Lt. Iti( �: 1• L• •
WAIVER SECTION
l understand that a pier, dock, mooring Pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15 from my area of rlpar m am" ur> m waived by rne. (if
you wish to waive ft setback, You MM.InBW the approprUde blank below.)
•.f • _ t ..`H :.r3 ff--
QT
.... I do not wish to waive the 1 5! sethac k recpiremenL
%t
(Riparian Ppape ni�rmatlon�
Mgrtarttmti
c Isar lei n��'► e
PrW or Type Name
60Ce1!3 yL
usftmftw
has p, C?A q� Z
CVSWWz0
TetepW* Number! Em" Addresa
5-/z 7
(Revfsed AuZ 2014)

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Scale: 1 *-20.
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