Kiley, Patrick (2)

CAMA / _- DREDGE & FILL
No 71343 A B C D
�. GENERAL PERMIT
Previous permit #
New ❑Modification El Complete Reissue
❑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 ElRules attacjhed.
Applicant Name ` � ' �` ''�
Project Location: County
i
Street Address/ State Road/ Lot #(s)
Address f
City.,] `� { t` ' ` State .—ZIP
Phone # ( ) E-Mail
Subdivision
r
Agent
Authorized ent
I I Lt C cam " �t '
�'ZIP
f � ' city
3�
`�' � � ❑� AAA e.-�jf5 TS
'� Phone # () River Basin
Affected N/A
❑
AEC(s): OEA [IHHF ❑ IH ElUBA El N/A
Wtr. Body ' (nat /man /unkn)
§.of 141x* /k' (
❑PWS:
Closest Maj. Wtr. Body
ORW: yes / no PNA /�es� no
Type of Project/ Activity
Pier (dock) length T
Fixed Platform(s)
Floating Platform(s) "
Finger pier(s)
Groin length "
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore 'y
Basin, channel
cubic yards /
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing {
Other
40,
Shoreline Length.%
SAV: not sure yes o
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:4 { _.-
( Note Local Planning Jurisdiction)
Notes/ Special Conditions Al
� E
Agent or Applicant Printed Jalame -
".,tip»...._.,.
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
rP I
(Scale: ' 00 )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature
F
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/ I-888-4RCOAST
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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: PAT r �k g.f
Mailing Address: 2 `� � ii1�1 Cr't-g
2 If
Phone Number: -(f an ts�- P
U143 4 i-3 S'SOq
Email Address:
I certify that I have authorized v iU L,'-- lcee PP-C r)(-� I+
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ; Q
at my property located at `1 2
in <:� 4- 9--� County.
/ 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:
411-�
P0-67ce
Si nature
Print or Type me
Title
3 , 29 12we
Date RECEIVED
JUN 112018
This certification is valid through / /
DCM-MHD CITY

,9ACEf RIPARIM PROOUMER STATEPPEOT
I hemby Certify i'hait I own property adjacent to iL t 1 e,., ss
(Name at' PU-QP^r J'€ , ^Men)
props" located at `2 i 2-5 M � � � �e� � 'jZ�, a y
(I-kddmss, Lod. Block, Road, etc.
on. �+� ,�.i��i L t2 v- , in KJ a---.k/P-, K.C.
�t7ai�ekaodu (Mx;1T6 r.,n andfor Countlt')
The applicant has described to rt?e, as shown below, the development proposed at the above
location,
I have no objection to this proposal.
i have objections to this proposai.
DESCRIP TI®C3 MIWOR DRAMPIG OF PROPOSED DEVELWMEMT
(9 ndAriduall prop-esing development rnuse ffll its descriptica beowt", or ar ach a siC,� c? a , invv
tip 1 Vd-i 2 : �, i, '�Gc.l� fa—?
9_ p ►o �sn n,
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WINVER; SECT Be l
I understand that a pier 2 doc;c, me oa trtg pilings, boat ra►-tip, brealwa er, boaLhouse, W..or ctrQir=
Must be set bad: a minimum distance of W from my area of rip. -flan access unless waived bpi
rite. (if you wish to waive the setback, you muss: initial the appropriate blar k below.)
( do wish to waive the W setback reC;-ttiremenL
I do not wish to waive the 157 setback requirement.
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ST afore . yy �i Signature*
Prent or Type Name rent or Tyne N/a�jr, %' ,� &
Mailing Address Mail,' Address
CAy/SiateTF � �p
Telephone N /ernaif address ema"'6MCEIVED
Late ®t
�Vali€t for one calendar year after signature
(ReWINY J 2ZOO114)
DCM-MHD CITY

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RECEIVED
JUN 11
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ADJACEMT RIPAMM PROPERTY ®M ER4 STA T F EET
I hereby certify that l own property adjacent to —P lA -� Y's -c �- K t I e w Ss
(Mame an- pPODa M f &^,finer!
p: opsty located at -- 9 2 M + 1) (I-2+sw k- R-0 ram;
(tAddmss, Lot- Bf0ch, Load, etcn
ran 4-A-ZAO;' i L- 2 - 1 Z , in _ � �u � aZ ! I ._ N.C.
(Uftt oodjr) (0a�tlr®tnum apncVar counl�f)
The applicant has described to me, as shown below, the development proposed at the above
location.
Cam- l have no objection to this proposal.
i have objections to this proposal.
BESCRIPT'IOM A MOR DRAMMG OF PROPOSED DEVELOP ?EMT
tl a` ersda�a9 I�rcn,�Tvit v� detselopment musg rill in descdpffba hnfdtir Orr 2e-,-4ech a sign-
R
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IFUTWER SECT, 00f)' )
I understand That a pier-, doc;:, mo. nrig pilings, boat ray -:gyp, br•ealwaier. boathouse, Hf-, or cjroir
t-tUst be set bad-, a minimum distance of W from Fny area of riparian access unless vuah d by
rite. (if You wish to waive the setback, you, Must initial i13e appropriate b12nk below.;
I d-- wish to waive the S 5T se6adk requirement-
44, 1 donot wish to waive the 95` seiback requirement.
(ProperLry Ou "Mer [nf-or•matiopl (P-W actin proW its
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r'rrnt or Type Nar, a Print or Type Name
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Mailing Address fvlly�g Add
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Cify/Siatelz-patP
Telephone Number/email address Telephone Number/email address °yt
4 f 4-f `7-( i6 ,2ECEIVEU
Date Date*
1falia icir one calendar year af<e:-signature'�� (fit
DCM-MHD CITY

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Spau^� "AftQAr wd 1 ,(-wa.% -> a e&c4v%c. s wft�-( RECEIVED
JUN I I Z018
�)CWMHD CITY