Boblin, Michael

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DCAMA / DREDGE & FILL Q
_ 71331 A B �. D
6GENERAL PERMIT Previous permit#
DNew uModification El 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 15A NCAC
ules attach.
Applicant Name a Project Location: County
Address " + _ Street Address/ State Road/ Lot #(s) °r
City s i` . State ZIP ` e !
=
r'•
Phone # ( ) �� U E-Mail Subdivision
Authorized Agent f) City ZIP
Affected ❑ CW _❑ EW .OPTA .{DES , a PTS Phone # ( ) River Basin
AEC(s): 1-1oEA ❑ HHF ❑ IH ❑ UBA El N/A Adj. Wtr. Body (nat/man /unkn
❑ PWS:
ORW: yes / no PNA yes /11o) Closest Maj. Wtr. Body
Type of Project/ Activity lg t , 1.€ , 1� /-,A
Pier (dock) length
Fixed Platforn
Floating Platfc
Finger pier(s)_
Groin length
--qumber
Bulkhead/ Rip
avg dista
max dist
Basin, channel
cubic yai
Boat ramp _
Boathouse/ B(
Beach Bulldoz
Other
Shoreline Len;
SAV: n,
Moratorium:
Photos:
Waiver Attact
A building pe......... , . yw..
( Note Local Planning jurisdiction)
Notes/ Special Conditions
i (Scale: / f 7 �� )
Agent or Applicant Printed Name t Permit Officer's Printed Name
oz
Signature Please r ad compliance statement on back of permit Signat re
Application Fee(s) Check # ISsuing Date Expiftion 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 -
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
(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:�icti �_IQ
Mailing Address: 5ilaRE- 9
/Vew/Pai- { /V "9iyJ ?6
Phone Number: ots v'� a L13 y.4 L4 S� a6g
Email Address: _ /I®�/Ie, co14
certify that I have authorized il 0 iA N J.ti 15
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: S 6q LA -)A i.t-,,
at my property located at d ©i�yk F k4 CDr-t N L
in L&rear County.
1 furthermore certify that 1 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:
1�11hvjt V
/i/4 , '�' - )
Signature
Print or Type Name
ti4
Title
ate
RECEIVED
This certification is valid through / 2018
JUN 13
DCM-MHD CITY

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RECEIVED
,JUN 13 2018
0CM-MHD CITY

ENT RIPARIAN PROPE
I hereby certify that I own property adjacent to U-A-e - G1 -2���' °s
(Name of Prop Owner)
property located at
(Address, Lo Blocl., Roa etc.)
on > in N.C.
(Waterbody) (City/Town and or C nty)
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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
p
W
City/State/Zip
W
Telephone Number
W
tY
Date
(Revised 611812012)
00
0
M
z

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
's
(Name of roperty Owner)
property located at J � 4 o r'e . &e o P 06- j'\J'� 2 'QZ-?, .
(Address, Lot PlocW, Roa , etc. (,.
on e U.-T 6 -� %� , u e- in ,& lr-)e ►' L Ca r�- N.C.
(Waterbody) I( ity/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)
�-�-}- Sea w a I
l �.- � 4 C,r�1. UCr e koc4d
WAIVER SECTION
Ipr�e Wa�
I understand that a pier, dock, mooring pilings, 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 wad the setback, you must initial the appropriate blank below.)
V do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Mailing Address
City/State/Zip
Telephone Number z�
I
Date
(Adjacent Property Owner Information)
p °r
W
Siyna re >
'K'4 xmoxd X 4 rA kin /� U z
Print dr Type Name LLJ
Mailin A dress
/ � �hvr�
City/State/Zip
f-, Lx r
Telephone Number
7').t —5���
Date
(Revised 611812012)
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