Kouacs, David

CAMA / ❑DREDGE &FILL Na 70466 A B C D
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El 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 I SA NCAC r / ules attached.
Applicant Name !,tl - Project Location: County
Street Address/ State Road/ Lot #(s) \°
Address
_ Al 1 t I j`fr;. 'A;
City
ZIP
Phone #
E-Mail
c
C,
Authorized Agent
--� -
❑ CW
``
-SEW „ EPTA ❑ ES ❑ PTS
Affected
ElOEA
ElHHF ElIH ❑ USA ❑ N/A
AEC(s):
❑ PWS:
ORW: yes / no
PNA yes / no�
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) e '
Groin length
number
Bulkhead/ Riprap length_______
avg distance offshore_
max distance offshore yy
Basin, channel
Subdivision
p r^
City ! `fl, .� ` y! ZIP, --
Phone # () River asin
Adj. Wtr. Bodyft q _ �'
na man unkn
Closest Maj. Wtr. Bodyr'�
cubic yards
Boat ramp o
Boathouse/ Boatlift__T__
i
_ 3
Beach Bulldozing
Other r
f �
i
Shoreline Length '
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
i�.
Waiver Attached: yes no 1-
i
A building permit may be required by:
( Note Local Planning jurisdiction) t
Notes/ Special Conditions `
e—
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
(Scaler )
rL-
® See note on back regarding River Basin rules.
Permit Officer's Prin ed Name f T
Signgatpre
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 complywith 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

��-
Name of Property Owner Requesting Permit: ]�\!1t7--
Mailing Address: `2'1 � � ��t'v���•1 �, �k
CbIP,N �S , _U �`� LJ
Phone Number: ,
Email Address:
�17
I certify that I have authorized e-7- __�? Agent / contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
V.
necessary for the following proposed development:
at my property located at
in L�� _County.
on
t furthermore certify that 1 am authorized to grant, Permit Officer and their age is to J enter
Division of Coastal Management staff, the Local
��'"�' tliv u'fvr �m�' �v' �"u iui iv.�i ii i Zvi ii'vviivi i VOL0 i v vuluuiii iy infv '�imuiivi i r �iui�iu iv t�iina
permit application.
opert
ner Information:
tuSignare ---�
Print or Type Name
IMee
Date
I
This certification is valid through 1 —
RECEIVED
JUN 04 '018
DCM-MHD CITY

CERTIFIED MAIL_ RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFiCATIONMAIVER FORM
Name of Property Owner: Dft)i 1D
Address of Property: � Xn �,21Lt��ic,(�`lt � ti i 1me1;) L� 1. N�
(Lot or Street #, Street or Road, City County)
Agent's Name #:
Agent's phone #:
Mailing Address: RECEIVED
I hereby certify that I own property adjacent to the above referenced property. The individual.' CITY
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions, must be provided with this letter.
Glr--� 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 90 days of receipt of this notice. Contact information for DCM offices is
available at;ittp•//www nccoastalmanagement.nc•JL-0,mb/cm/staff-listin4 or by calling 1-888-4RCOAST.
No response 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 initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
ty
�a1 f I do not wish to waive the 15' setback requirement.
Prope O Der info tion
Signature
Daw tD 1Ccsv S
Print or Type Name
Mailing Address
City/State/Zip
(_.C)03--2-S2.
Telephone Number / Email Address
V lD iC 4u fiC'_`.� 3 4-1 L. , (2mk-k
—E51Dwe
t3 --------- -
(Riparian Property Ownef Information)
�'
Signature
Print or Type Name
JZ 3i0 l klia`�1 C.",rv;)--i fey
Mailing Address
UWstateop
Telephone Number/Email Address
Date
(Revised Aug. 2014)

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can retain the card to you.
■ Attach this card to the back of the mailpiece, {
or on the front if space permits.
1. Article Addressed to:
4 ❑ Agent
❑ Addre
B. eived by (Prinfed Nary C. ate of De
D. is delivery address different from item 1? ❑ Y
If YES, enter delivery address below: [j No
3. Service Type
❑ Priority Mail Express
❑ Adult Signature
❑Registered MailTM
II
I
IIIIII
IIII
III
I II it
II it
1111
I
I II II
I i II
I II
I III
❑ Adult Signature Restricted Delivery
17 Registered Mail Restricted
9590 9402 3402 7227 4015 76
❑ Certified Mal®
❑ Certified Mail Restricted Delivery
Delvery
0 Return Rece pt for
Merchandise
❑ collect on Delivery
❑ Collect on Delivery Restricted Delivery 0 Signature Confirmation
2. Article Number (transfer from service label)
'Mail
0 Signature Confirmation
7 016 2 D 7 D 0000 1605 4441
Mail Restricted Delivery
Restricted Delivery
,soo>
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
M
RECEIVED
JUN 04 2018
DCM-MHD CITY

Dock Live Load of 62.5 lbsisgft
Low Profile Dock Live Load 30 lbs,'sgft
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NOTICE! Read HZ Dock Limited Warranty carefully. Among other things, EZ Dock does not warrant damages,
failures or defects caused by unauthorized modification of EZ Dock Product, and; or unauthorized attachment to;of
EZ Dock Product.
14'
11'-4"
MADE IN
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Project Name:
,NC
Distributor Name:
David Anderson
EZDock Solutions
12521773-0793
Drawn by: Devrd .Anderson
Date: 4 26 2019
DWG Name: 00043216598676
EZ Dock, Inc
878 East Highway 60
Monett, Missouri 65708
Phone: [phone]
Fax:[phone]
General Notes:
I_ Ihs dravnng does net reflect anchoring. once st:fiici-M informanonS
<omplc!cd Prorwsal Req,,CA Porn concerning wa:cr and bottom conditions
is rccc—e, anchom:g -y 1> detailed.
2. Notc: it is the dock owner operator's rospons:bihty to ascertain and comply
with a:l applitab!c Fcdcml, Stu-. and local Iaws, urdinanccs and
mp!ations, as well as as inspection, pcnr.!«ing and licensing rccl—trenta
penaimng to the Instailanon. application and uw of EZ Dock products on
the mvnerr operator. premises. L•Z Dock, Inc. assumes no duty or
mponsibi!ity with respect I the legality or compliancy of the
o%n cr'oporatces chosen inste!!ation, app: Ovation or use of EZ D mk
prodaels.
3. Refarenco U Dock LTvner Mamiat for additional dclnils.

6/1/2018
5306 Trade Winds Rd - Google Maps
O gl2 MapS 5306 Trade Winds Rd
Imagery @2018 Google, Map date 02018 Google 50 ft
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