Fairman, Mark

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❑CAMA / ❑ DREDGE & FILL No 70456 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 Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached.
r Project Location: County
Applicant Name " I
Address _ Street Address/ State Road/ Lot
City State ZIP — -
Phone # O E-Mail Subdivision
Authorized Agent City _ ZIP_ _
❑ CW ❑ EW � PTA El ES ❑ PTS Phone # ( ) River Basin
Affected ❑ OEA ElHHF ❑ IH [I USA El N/A AEC(s): Adj. Wtr. Body _ gnat /man unknn)
❑ PWS:
nRw vPt no PNA ves / no Closest Maj. Wtr. Body— —
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) i
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp .�
Boathouse/ Boatlift ,� <
Beach
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
o
;'
Agentr Applicant Printed Name
. ,•• j
Signature Please read compliance statement on back of permit **
Application Fee(s) tk #
(Scale: 1 -"-
Seenote on back regarding River Basin rules.
Permit Officer's Printed Name
Signature f "a
�~ ) 77to
i �
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 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 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 - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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
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

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4412412018 16.11 #119 F.0021002
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _. Mkx A. ��.?�� �t+i `s
(/chine of Property Owner)
property located at l2 ;c�'orff4 pig t�
(Address, Lot, Block, Road, etc.)
(Waterbody) (Cityirown and/or County)
The a plib n, has described to me, as shown below, the development proposed at the eve
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 fill in description below or attach a site drawing)
Povt" rlt,lrl
rb T j'j s ol�f
Aver rN t- &'ti I.1Ar'
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 v sh to waive the setback, you must initial the appropyta blank belo,)
V` j tj) g11 ;i i r� c i/I'cc
' 1 do wish to waive the 15' setback requirement.
i do not dish to waive the 15` setback requirement. � oaI
(Prop" Owner Information)
(Adjacent Property OwnerWorrnation)
c1t
.BSI fain-
�t3�xf?fltitie'
Print or Type Name
FlfTyl
hfailin Address
Maid' g d1
ip
+cii '�
Jcity/Stat
t
.
Telephone Number/ entail address
Telephone
Vt/6 rp gi2y�i$
Dal
`Valid for one calendar year after signature"
1
CC
(Revised Aug. 2014)
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I hereby certify that I own property adjacent to
fl e,, A . KJ4fA-tJ
(Name of property Owner)
property located at2-5 14 LA-1 V,,.__
(Address, Lot, Block, Road, etc.)
(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.
DESCRIPTIONAND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
41
t
w_M
o
WAIVER SECTION
I understand that a pier,: dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
roust be set back a minimum distance of 16 from my area of riparian access artless waived by
me. (if you wish to waive the setback} you roust initial the appropriate blank below.)
I do Nish to waive the 15' setback regUirem nt.
€ do not wish to waive the 1' setback requirement
(Property Owner Information) . dj gent Property Own Infort.ation
.fit qt atrer e
Print or Type Name Type PWk �
Mailing Address or a We
..
'fir ...
f3 e
el+ c z rif f dt r sTelapO fiefvur t Or/ entail address'
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0411112018 15.58 #112 P , 0021002
AWACl"NT RIPARIAN PROPERTY QWNER STATEMENT
I hereby Certify that I own property adjacent to pp'e' A. } f4)e,mA,4 s(Name of Property owner]
property located at 125 14bop 17014 C.tirL lc RJR ry&
(Address, Lot, dock, Road, etc.)
on ROOF i'O(L t�.tf,t< in '1GArl71G Eliclt N.C.
(Wate ody) {CIty/Town and/or County)
The appl nt has described to me, as shown below, the development proposed at the above
I
t have no objection to this proposal.
1 have objections to this proposal.
DESCRIPT ON ANDIOR 1RAMNG OF PROPOSED DEVELOPMENT
(lricliv;duatrapoarng dveroprn,enxt�ti/1,1nlc�l�atloA.taeli+y ot:i#ir`cit side �traroin9)
tyovt a
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WAIVER ftPM N
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 or 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,
Owner information)
Si rxtr�re
Print or Type Name
�Malin Address
ric- Barrk W . 28 - i 2.
citvlStawZip !
(gfaj5$e�fC�jrtl r+ftf��i;.linL-���l�i�!�"
Telephone Numborl email Address
.//rt/r S
Data
`Valid for one calendar ,year after signature`
{Adjacenperty Qwner Information)
�t$7fGiur
Print or Type Neme,
Mailing Adds ��h
CttylStatelZip o
t•�
l"ctephona Number! emailadd
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(Revised Aug.2Atd)

i hereby certify tn2t 1 ovin prop
prcperty located at
( t r )
fn d�ilpllc nt has described to n1e, as shown below,
to stir �
jectid�i to this propo,,,;aj
DESCRIPTION DRAWINGfit
(In dividti l proposing developmontf fill it)
understand that a pier, d ,
must be set back a minimum
me, (if you wish to waivethe

+M
Styron, Heather M.
From: Mark Fairman <[e-mail]>
Sent: Thursday, May 10, 2018 3:43 PM
To: Styron, Heather M.
Subject: RE: [External] 125 Hoop Pole Creek Drive pier extension?
Heather,
Alan Bailey is going to be doing the dock work for me. He said he can go by and pick up the permit from you. Will that
be ok?
Thanks,
Mark Fairman
From: Styron, Heather M. <[e-mail]>
Sent: Wednesday, May 09, 2018 2:54 PM
To: Mark Fairman <[e-mail]>
Subject: RE: [External] 125 Hoop Pole Creek Drive pier extension?
You're welcome. No we are open Monday -Friday 8am to 5pm.
From: Mark Fairman [mailto:[e-mail]]
Sent: Wednesday, May 09, 2018 2:48 PM
To: Styron, Heather M. <[e-mail]>
Subject: RE: [External] 125 Hoop Pole Creek Drive pier extension?
Thanks Heather. Ya'II aren't open on Saturday are you?
Mark
From: Styron, Heather M. <[e-mail]>
Sent: Wednesday, May 09, 2018 1:35 PM
To: Mark Fairman<[e-mail]>
Subject: RE: [External] 125 Hoop Pole Creek Drive pier extension?
Hello Mr. Fairman,
The permit is ready for pickup. The fee is 200 dollars and we take check or money order.
Thanks,
Heather
i