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wAMA / REDGE &FILL No 7U487 q g t C D
GENE L PERMIT Previous permit# ''`
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue i Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area 9f environmental concer),
pursuant to NCAC
/� ❑ Rules attached.
Applicant Nam { t� '� ` � J r , reject)ocation: County _—
Address i 1 } I- ✓ '' Street Address/ State Road/ Lot #(s)
City State ZIP - � J� ( t ' Gil / L
Phone # "(! ►6 -E_Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ElHHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Subdivision
City / i ZIP
Phone # ( /-' River Basin
Adj. Wtr. Body— (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Permit Officer's Printed Name
Signature
ApplicationFee(s) Check# Issuing
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/ I-888-4RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(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: 252-264-3723
(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: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: J j... , I , /aQ,
Mailing Address: .3 1 1 j G (en t opa_—1 A-11�
Gee=s NC --
Phone Number:
Email Address:
I certify that ► have authorized 6vy, r - , ( t-=;p 1 � 8 P m
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
if I s "I n,,-1.,j county.
l 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:
/j Signatu e
GC -
Print or ype Nam
Trflee(
15-1--1.—I1(L
Date
This certification is valid through
Ij
RECEIVED
MAY 212018
N4,
WOW,
{.Have no
. ihfs propase�. .
� imam �, �`. o'
YOU w�df�o
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ram. ;.t �s0.iieh to Weft
reticrfreMeM
r
RECEIVED
Imm 21 J0
D ,M_MHp CITY
.1'
The aWk" has ('-�tTown: Y , 1Y u,
is . to �, at shown wow,
i hffift no ObjeWan in ft propp WOPosed the above
- — --,- have Objedons to this proposal.
�AhdMduWdeve]�D/aR DRgWING. OF pRp
art must f�ti In
""Grated th t a pier docC
met be aat beck a , "Mft � �
.�1f Leh tp the ftMrft of IV trft.1 � of .butt , pR. (jr groin
)you n t* SWOPftilft Wwtfts d by
ftive fhe 15' aback
W Wish to waiftthe 15' k
�refierrt.
t�►aant ,ep�bOwftw
1)
Nft tar one Ym after signattge,
MAY 21 2018
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