Moore, Stephen

Al
-CAMA / ❑ 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
Applicant Name_
t� jf
Address ``° � t � `
1_ZIP
City
_ _Mate
Phone # (�)
E-Mail -
Authorized Agent
�.�
CW EW
NrPTA ES ❑ PTS
Li
Affected
❑ HHF
❑ IH ❑ UBA ❑ N/A
AEC(s):
PWS:
C)RW ves / no PNA
Yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_ --
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing r
Other
I
Shoreline Length i 11i
SAV: not sure yes no
i
Moratorium: n/a yes no
Photos: yes no
i
Waiver Attached: yes no
A building permit may be required by: m>
( Note Local Planning jurisdiction) t
Notes/ Special Conditions
Agent Applicant Printed Name
signature Please dead compliance statement on back of permit
Application Fee(s) Check #
No71359 A
Previous permit #
Date previous permit issued
-- Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
B C D
Subdivision _
Citv
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body_
ZIP
River Bali-
'" at /man /unkn)
(Scale:
- r C See note on back regarding River Basin rules.
PermitOfficer's Printed Narri, y
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 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/ 1-888ARCOAST
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

F
Owner Requesting Permit: S�� �-��--� � G
Name of Property Qw q g
Making Address.
Phone Number, -
Email Address;
I certify that I have authorized _
t AMA eits
to act on my behalf, for the purpose of applying for and obta�nmg al Prm
necessary for the fat ing proposed d
v
at my property located at _. _. 4
in (,..0 r, (C° rCounty.
l furthermore certify that l 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:
lynature
Print or Type Name
r r
Date
This oerfification is valid through
RECE1VEp
-lUN 212018
DCMM_MH® C17-y

CERTIFIED MAIL - RETURN REQgIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT.
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Aif dress 0propel%l.
I& cT Street ir, SiTast or Road, CXy Count; )
Agents Name # MaftAddless:
Agents phone
I hereby cei* that I own property - adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the aft-ched drawingjhe developrnent
' --- -
they are proposing. kgeampw � �d�� -d ..M&
I have no objections to this proposal. 1 have objections to his proposal.
W
ifyou have objecdons to whatisbehigpropased, youmustnoffyV)9D*&w of CoaslalkWagement
(DCM) in WINkig within 10 stays of rece4)t of this notice. COMW bzkmmftn for DCK offices is
availableavailableat no . arby cWft 14MO-4RCOAST.
No nMgm is consideredconsideredthe same as no oblectfan if you have bew-noffibd�y CerMAW.
WAIVER SECTION
I understand that a pier, dock.. mooring pilings, boat ramp, breakwater, boaMouse, or Hit must
be set back a minimum distance of 15'fro my area of rim-irinnaaess
you wish to waive the setback, youin-an Ulf by me. kit
ate appropriate blank below.)
do wish to waive the 15'setback requirement
I do not wish to waive the 15'setbac, requirement.
(Property Owner Information) .
Signatwv
/-I -
-:D*1[T-'Ht!-i LACLvE
Pdnt or Type Name
IlWft Ad"ss
7-,
t'!( l/�kf)' �j
T&i9PhCn8,AiuraberfErpai7Add,-&ss
PMPA
(Rinadan Property owner Inforim.,ation)
A4Z'4;-A
Signaft-re
Al�eA
(A316P-n, -AC 7-110 3
(P/ 2-0,
Date
RECEIVED
i U N 21 2
DCM-MHD CITY
1ReVkWALfg W14)

ADJACENT__RIPARIAN PRQPERTY OWNER STATEM 7
I hereby certify that 1 own property adjacent o '��CI'y,� ('�y C! - I
�-► (� , C- t-�Name of Property Owner)
property located at
`�
(Address,
�,�i c.
on S 6CA' ^ .. inN.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
localir,
µ I have no objection to this proposal,
s
I have objections to this pror)o al
DESCRIPTION AND/OR DRAWING Of PROPOSE? DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAN
�SECTiON
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse. lift, or groin
must be set back a minimum distance of 16 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) (Adjacent Property Owner Information)
RECEIVED
iUN 2 12018
'r,-OC NI -IAA H D CITY
Fwnt or We Nam
�,� �~ Mailr Aariiress
citylstatemp
I elep ne u ! e T Numbw email address
tRevrsed Aug. 2014)
'Valid for one calendar year after signature,

Dock Live Load of 62.5 Ibs/sgft 0 H MADE IN
Low Profile Dock Live Load 30 Ibs/sgft - V USA
Wc.d
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29'-3"
13'-8"
$roject Name:
NC
6istributor Name:
David Anderaun
EZDock Solutions
[phone]
(j Drawn by: David Anderson
Date:fiN;2018
DWG Name: Ii00_43229532451
EZ Dock, Inc
878 East Highway 60
Monett, Missouri 65708
Phone: [phone]
Fax: [phone]
tQOTICEI Read 87. Dock Limited Warranty carefully. Among other things, C7. Duck does nut warrant damages,
failures or defects caused by unauthorized modification of EL Dock Product, and or unauthoriud attachment to/of
F.Z Dock Produc,
.
General Notes:
I. Thisdrawing does not renect anchoring. Once sufficient infoonatial @
completed Proposal Request Form concerning water area hounm coed tom
is received, anchoring may be detailed.
2. Note: It is the dock owner/operator's responsibility, to ascertain and comply
with all applicable Fealcral, State, and kcal laws, ordinances alul
reguladnns, m well as all inspection, pertaining and licensing requirements
pertaining to the inaallation. lipplicariun and use of U Cock products on
the odmerropermur's premises. F7. Dock, Inc. assuncs- duly or
responsibility with respect to dre legality or compliancy of the
ownerroperann'a Ouse. Installaaon. application or —of F7 Dock
products.
3. Referencr EZ Dock Owner Annual for odditinnal details.

6/20/2018
240 Oakleaf Dr - Google Maps
G4 gle Maps 240 Oakleaf Dr
Imagery 02018 Google, Map data 02018 Google 50 ft
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