O'Neal, William

�2CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
—'New ❑Modification ❑Complete Reissue El 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 I SA NCAC
No71339 A
Previous permit #
Date previous permit issued
Applicant Name ,J Project Location: County
Address_ . ; I r « Street Address/ State Road/ Lot #(s)
City i(if (4iV-�ItaterZIP
Phone # 1. -Mail
Authorized Agent
Affected J CW —❑ EW r I PTA ❑ ES .�PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
❑ Rules attached.
B C D
Subdivision
t f'" ,City ZIP
Phone # ( ) River Basin / /f f7e Jr1
rr�
Adj. Wtr. Body (nat Amp-7unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Y _{
Pier (dock) length f
I I.
Fixed Platform(s) — - E
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length—
avg distance offshore
I
max distance offshore —
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulld
EEON MOP NONE IN Ell
IMEM M MAIMEN 6MI WE
0 arm
ME
ME ME No =MMU
INN
NE MEMWmom
MEMO
Agent ctr A 1icant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
p � r
(Scale:
❑ See note on back regarding River Basin rules.,
Permit Officer's Printed Name l
t-�7�LrF
Signatur
Issuing Date Expi tion 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: _ CO 1 i ra 0 �j
Mailing Address: ) 22 ,V�-j-'
P 105 n! 4�
Phone Number: 1 l G — Gl U,Z- 2-1
Email Address:
I certify that I have authorized rm V D '6 L' C1C-(F7 D e-m- nG t oss 'X—.,U c
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
. IJ '!�00">
at my property located at
in �sZ-er�,� 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
�wry -e^
Title
RECEIVED
Date
JUN 04 2018
DCM-MHD CITY
This certification is valid through / /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I ( I i rn ®i rG'q (-- 's
1 2 2 l� �$ L same of Property Owner)
property located at i 1 YZ. C I (F
(Address, ip#, Block, Road, etc.)
on C IN �-.., , in T t )yJ 15 V rvo 0 -�5 63re-S , N.C.
(Waterbody) (Cityl%wn 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 rC ti'IN11t L
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9(aCc,/3�c�JS
L1�c15 i1 , 3 %)bC.0
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathou6te.n
must be set back a minimum distance of 15' from my area of riparian access unless wa' Aly
me. (If you wish to waive the setback, you must initial the appropriate blank belo�I)
J
I do wish to waive the 16 setback requirement. N 0 4 2018
1 do not wish to waive the 15' setback requirement. ®CM-MND CITY
(Property Owner Information) (Adjacent Property Owner Information)
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t atu a Sign e
Print or Type Name Print or.Typ Narpe p
dig ng Address t�laili Address
�►(S 0, e. z�S ( Z. Q C /l 6 kork
City/SYat&Zip Cur/StatWDD
Telephone Number/email address
45 - 4- I<6-
Date
e�2 -,S 2 - !72 7.. . - y
Telephone Number/email address
��
/
Date
(Reviseal.qug. 2094)
*Valid for one calendar year after signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to r 1 6 C Is
property located at 2 Z W 4 C !U ci ( (No` of Property Owner)
C l ie.c
on
A A 4 C- (Address, io"lock, Road, etc.)-
in N.C.
(Waterbody) -(CityiTown 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.
DESC11410TiON AND OR DRAWING OF- PROPOSED DEVELOPMENT
-(Individual proposing development must fill in .description be%ur or attach a site drawing)
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A K'P l h, aq C �.
G� eL"IJ5
WAIVER SECTION
I understand that a pier, dock, mooring pilings, -breakwater, boathouse, Nft, or groin must be set
back a minimum distance of 15' from rrti.area ofi riparian access unless waived by me.
wish to waive the setback, you must initial the'�"EIvED
_ appropriate blank below.)
I do wish to waive -the 15' setback requirement. JUN 0 4 2018
I do not wish to waive the 15' setback requirement ®CM-MHD CITY
(Property O'"'ner In%rrnation)
(A "ace Pro rty Owner Into"ation)
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Si re
Ri int or Tyke Name
Print -DrMe Name
M tlirtg Address
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, hWZ' Address
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ctty/StatelZip
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t� f ernaila ��
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Date
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11
Date
*Valid for one wlendar year af-ter signature' (Revised e/18/ M)