Browning, Joseph

ti
--ICAMA / '. l DREDGE & FILL
GENERAL PERMIT
_'New Modification 'Complete Reissue Partial Reissue
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
7 Rules attached.
Applicant Name AQ Project Location: County
_ i !
Address 4 f '/ ;`` (" Street Address/ State Road/ Lot #(s)
City 1 r 3 StateNZIP.,., �
Phone # ( -_) _ _ E-Mail _ Subdivision
Authorized Agent -_ City
El❑ ❑ CW EW PTA EUS R'PTS Phone #
Affected
A Affected
ElOEA ElHHF F IH ❑ BA El N/A Adj. Wtr. Body
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)--
I I
Floating Platform(s)
Finger pier(s) _ r
Groin length
number
Bulkhead/ Ripraprap length}'
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift x `%
Beach Bulldozing
Other
Shoreline Length_
SAV: not sure yes
Moratorium: n/a yes noµ)
Photos: yes no�
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on backof permit"
Application Fee(s) Check #
No 71333 A
Previous permit #
Date previous permit issued
B G D
r _ A
_— ZIP ,t
River Basin f
(nat /man /unkn)
(Scale: )
❑ See note on back regarding River Basin rules.
rin !
Permit Officer's Printed Name
SignatuFe I-�
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:
U Tar- Pamlico River Basin Buffer Rules Other:
E 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)
(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)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
N c
Phone Number: 9
Email Address: -)Dcc WA^ �(,-x L . C'C. cAyM
I certify that I have authorized b'<o rras r) V"?l 6V,.C�e'�
Agent Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: V"t�vV("I 1 G J �4-'�tk.
at my property located at GA VJA�"'N�
in-�"C{ County.
l furthermore certify that / 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:
Signature
Print or Type Name
Title
Date RECEIVED
AJN 15 2018
This certification is valid through I 3 I I } DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to . h 's
l (Name of Property er)
Property located at � � �%�n I n N + C � r< <.Z
(Address, Lot, Blo k, Rod�etc.)
on (.Go n� { , in IP , r7 lrw 11 J I 'r e S , N.C.
(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 ANDIOR 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, 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 16 setback requirement.
r`' I do not wish to waive the 15' setback requirement.
(property Owner Information) (Adjacent Property Owner,formation)
Si re Szgrilc 7 * C I 4n AY-J
Print or T Pe a e Print or Tvpe Name
IingAddress
t'
V% rl 'nM IN
Ci Y'State/Zip
3 - lI UJIS oz�Nwn+v�g011C. ((JO
Telephone Number! email address JJ
Date
*Valid for one calendar year after signature*
Mailing Add 0-1 ' c� 0(' ZA r 5
MQ /g i p - 3D2- 5z`ts
Telephone Number/ email address
(�����CEIVED
Date*
(Revised A 41i)2018
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ���e4
(Name of Property er)
property located at Wll � LA — x r(
1 (Address, Lot, Block, Road, etc.)
on , in P,rk t" % V-U(\�ZJ , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
iocatior�,
�_ 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)
C
� a
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.)
tea 0. I do wish to waive the 1V setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
a �Rrowyl�.
Print or
!TfinnAddress 1
City/iate2i
Telephone qumbeemail addres
Sig -Alit
Date
*Valid for one calendar year after signature'*
JUN 1 J LU10
(Revised
CITY
ITY