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CAMA / ❑ DREDGE & FILL No 71311 A B C D
GENERAL PERMIT Previous permit#
❑New E]Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ` I
and the Coastal Res urces Commis 'on in an area of environmentaltconcern pursuant to 15A NCAC
i- EIRules attached.
Applicant Name I`'� '' Project Location: County
Address (' % " �� =�` ' t ., i Street Address/ State Road/ Lot #(s) _
i State ZIP
City ; �^!)� L. ► .�
Phone # /� /' " --Mail Subdivision --
Authorized Agent �" City - ZIP_
ElCW ❑ EW ❑ PTA [I ES ElPTS Phone # () River Basin
Affected [IOEA ❑ HHF ❑ IH ElUBA [I N/A AEC(s): Adj. Wtr. Body (nat /man /unkn)
❑ PWS:
Closest Maj. Wtr. Body -
ORW: yes / no PNA yes / no
Type of Project/ Activity�`r---
__
Pier (dock) length ---
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
t.
Bulkhead/ Riprap length
avg distance offshore
max distance offshore— Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing "
Other
Shoreline Length
SAV: not sure yes o
t l i
Moratorium: n/a YQ5 5+' �.. ....._-
Photos: yes
Waiver Attached: yes &0
t"
A building permit may be required by: Seeote on back regarding River Basin rules.
( Note Local Planning jurisdiction)
i.
Notes/ Special Conditions i
Agent or App6 t Printed Name Permit Officers Printed N e
Signature Ple�sg ead compliance statement on backof permit* Signature
Issuing Date Expiration Date
j Application Fee(s) ec
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
r head City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
Fax: 252-247-3330
(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)
http://portal.ncdenr.org/web/cm/dcm-home
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(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)
Revised 7/06/ 17
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 90VIAZI a. 4:P69 &Y, K's
(Name of Propert� Owner)
(Address, Lot, Block, Road,etc.)
(Waterbody) (CityfTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
RY ' |hovmuoo�aodontoU�spvopoomi
~���
|have objections bothis proposai.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
Conal Easement
iron P%es,—
To Deer Creek
Mag. Nail Set 0.76' 35.65'0- IIROPR-ot�" . rn
-Pixop'—Cr ery I.--- I VVAIVER SECTION W&L JA) FR.*,,JT OF 9x51'S-rJAr:t
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' irom my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
le
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to
`� (Name of Propert} Owner)
property located at'7;$_K. ✓F !„a �' 23 _.- _.
(Address, Lot, Block, Road, etc.)
n �'�._ , in _FQ� N.C.
o
(Waterbody) (CityrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
!*.AI 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)
Canal Easement
--' S 61.52'20 "W
-._. 4 7.8 6 $-------
CrA.NA�
To Deer Creek C not \ \ ca
S 54,33'27"W
21.25$
��X�fExisting
iron Pipes
\6ft
S 82'20'50"W 4 8ulkhea�d \ U � -'� <� A I, i^ d t�
Moo. Nail Set 0. 76' 3Jr, 65 v- -' Dock
North of Lot Co
-To►t>JSa�i
�'�Zol'>~R7`f �_. WAIVER SECTION WALL 1A1 rAo,"JT nr X157I�C�
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 wa-Ne the 15' setback requirement.
I do not wish to waive the 15' setback requiremert.
(Property Owner Information)
Sianaiure
Print or Type Name 22��
lariinq Address
Gitt IState: Lip
Telephone Number l email address
r'�rte
(Adjacent Property owner miumidtlulli
11a1w.
Print or Type Name
Mailing Address
City,'State Zip
Telephone Ngi mbeY! em• it address
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that i own property adjacent tol�R�..._e�.�s G .__.I_' _.LIt_...'s
(Name of Propert� Owner)
property located at
(Address, Lot, Block, Road, etc.) _
on ,E. _ JE in � � � N.C.
(Waterbody) (CitytTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
��ave
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)
C A
To Deer Creek
S 82'20'50V
Mog. Nail Set 0.76' 35.65'
t C rner
S 6 9'52'20 V
,..1 47.860 ---
-�--
-i Bulkhead \\ v{t
19.2' 6.a.,
5.2' Dock3
Canal Easement
S 54'33'27"W
2 J .25'
Existing
iron Pipes
<- A L.l-OF
,PR aP�!~7 }1
North of La
Tor{rJSo�
-Ffto Pe; Q- Y _1... _ WAIVER SECTION WALL JAJ FYO,0,)T 0x1Sl,ASS
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 m,r, area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not w'sh to waive the 15' setback re: uiremert.
(Property Owner Information)
Si �Plafure *�y
Print or Type Name
7�ailinq Address
.t~ �} f.nlC
Gif %state: Zip
Telephone Number! email address —
(Adjacent Property Owner Information)
1
KUN7'
'L ' a , ,T 4 �✓1 o r-)
Print or Type Name
may"
Mailing ,address q
city,'State z.ip
Telephone ,'e mber t em- d address
Dcrtr"