NC Aquarium C/o Michael Fatzinger

- CAMA / F-1 DREDGE & FILL Na 71332 A B C D
GENERAL PERMIT Previous permit #
DNew —! Modification L'I Complete Reissue ED 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 conc1m pursuant to 15A NCAC
Q.,Rules attached
A
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Name Applicant Project Location: County
Street Address/ State Road/ Lot #(s) )J
Address
City Stated ZIP
E-Mail Subdivision
Phone#
("
Authorized Agent City -ZIP
Affected EI Cw El EW El PTA El ES El PTS Phone# River Basin 'Ie 6
[71 0EA [I HHF EIIH E UIBA El N/A at /
AEC(s): ❑Adj. Wtr. Body �1) �1- at man /unkn)
[1 PWS:
ORW: yes / no PNA yes /, no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
Bulkhead/, Riprap,fength 1 C)11 X
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yep4 noit
— — —
Moratorium: n/a yes -d
. .... ..... .
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agentor Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
fry r,� /I
(Scale: / I )
❑ See note on back regarding River Basin rules.
V
Permit Officer's Printed Names
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 howto complywith 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: [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 FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: S+Qj-c- ©F NO -AC A6L)Cdt YMCtf PL
Mailing address: I (�'iQi ( SerVIC-e
ZCk1 (2�l Ctk , I\JC. A3 -+�, � - 13 aI
Telephone Number:
I certify that I have authorized 11 C CC)Us�,l a d e(-Cj:t4 Cri (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 6(-e,I in,2 5f(�i 1 l Ott-i or�
at my property located at !V d t �i (V101� `S%1OfL°SL�J C, a 5 I a.
This certification is valid through �n tq (date).
(Property Owner Information)
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Print or Type Name
i Pa cTv 2. N C A-ifx\jAfZ-10.ten
Title, co. owner or trustee for property
1 I J Q r. 20 IS
Date
sZ- 2-y-/V003 Ex Zzz
Telephone Number
Email Address

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to op 4)00G! l L,m,s
(Name of Piroperty Owner)
property located at 31y C(
(Address, Lot, Block, Road, etc.)
on - e v c) Q% in k�s , N.C.
aterbody) (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)
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
I "as'yt-L r-
M 'ling Address
1 %N g S\-tcut€.S .
C IState/Zip
ZS Z�Zy 7-�UU 3 ��c t ZZZ
Telephone Number
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Date
(Adjacent Property Owner Information)
Signature
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Print or type Name
?e.a.-o q%C�
Mailing Address
City/State/Zip
Telephone Number
6-tr• Is
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to� W-,! U J 's
property located at Z <4 L) ( i- - r (Name of Property Owner
(Address, Lot, Block, Road, etc.)
on
(Waterbody)
in ', r N.C.
(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.
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
WI1 C �z Zinit✓ �L
Print or Type Name
ROosCVCL-T 61 J�7
Mailing Address
/�i fif kWC L L-S Hv tJ C , Z ASS 12_
City/State/Zip
2-SZ-2`J-7- 41003 t xr ZzZ
Telephone Number
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Date
nt Prpperty Owner Information)
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Mailinptp55ss
City/State/Zip
2-52ZyT 535P
Telephone Number
Date
(Revised 611812012)