Clark, Craig & Gwen

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CAMA /❑1 DREDGE & FILL Na 1 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 r� i f- I
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC d`
Rules attached.
Applicant Name �' t } Project Location: County
r —-` .
Address Street Address/ State Road/ Lot #(s) j
Y�
City
Phone # ( y L ► E-Mail
Authorized Agent
ElCW NEW A
Affected ❑ OEA ❑ HHF El IH
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)
Groin length
number
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 In`o
i
Moratorium: n/a yes o
Photos: yes o
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
IQ C ,HI
Agent or
State ZIP Y
€S ❑ PTS
UBA ❑ N/A
I
Signature. PleasAkead compliance statement on back of permit
Applic tion F e(s) Check #
{
Subdivision
t
City t.;' 'c' '
' ZIP I
Phone # O f i ( y' ,l River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body '
r
(Scale: Y ' )
❑ See note on back regarding River Basin rules.
�•--
yr;
-�; \!
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, 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to G >E G ill 's
(Name of Property Owner)
property located at 1,0
��A
� (Address, Lot, Block, Road)
on R S. jgeel _,in_ 1r,04�Iitl N.C.
— r (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing/development must fill in description below or attach a site drawing)
5'el e iq
#$4 e
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 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.
(Property Owner Inftion) (A41acV Property Owner Information)
Signa re Signature
CIA
Print or Typ e /- Print or Type Name
Mailing dress Mailing Address
A C 4d �i' l�.01-C,,1sa,4 513c old i-J G 2,65�
Cit IStateZ;ip City/State/Zip
Y1110 /C/4/47-041eG�%f, g/D3ZS73j�� S�JGvZ�� C��
Telephon Number email ad ress Telephone u er/email address RECEIVED
Date Date*
IUN A S Z018
(Revised Aug. 2 14)
*Valid for one calendar year after signature* ACM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to s
�� (Name of Property Owner)
0� �K �
property located at
k6
/ Address,,1Lot, Block, Road, etc.)
on �/� �' QQ in l.m Kam -I W N.C.
( aterbody) (Town and/or County)
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
//� f Zai
Date
DECEIVED
JUN 18 2018
DCM-MHD CITY

Receipts for
Certified Mail
(Staple Here)
ate
Adjacen Pro erty Owner zQ��
Ma!,n Address
.✓C- 2656
City, State, Zip Code
Dear Adjacent Property:
This letter is to inform you that I, PAII� have applied for a CAMA Minor
Pro erty Owner -§.-
Permit on my property at " Wr (�� ` -in COUNTY
Ppopelty Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required tom you or you may sign and return
the enclosed no objection form. if you have any questions or comments about my proposed project, please
contact me at 2 J o�'Q4f t, 4 /4 or by mail at the address listed below. If you wish to
Applicants Telephone
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program, you may submit
them to:
Sincerely, ,
b"
Property n41
Mailing Address
"tWP
City, State, Zip Code
LPO NAME
Local Permit Officer for LOCAL GOVERNMENT
LOCAL GOVERNMENT ADDRESS
CITY, STATE, ZIP CODE
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RECEIVED
JUN 18 Z018
CCM_t0HD CITY
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ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
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