McGregor, Addie

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
Address
City-
State
ZIP
Phone #
E-Mail
_
Authorized Agent
(r'
` CW
❑ PTA LiES
C PTS
Affected
\W
OEA
AEC(s): _
HHF ElIH ❑ UBA
❑ N/A
PWS:
ORW: yes / no
PNA yes / no
Type of Project/ Activity
Pier (dock) ia. h
Fixed Platfc
Floating Pla
Finger pier
Groin lengt
numb
Bulkhead/ I
avg di
max (
Basin, chan
cubic
Boat ramp
Boathouse)
Beach Bulk
Other _
Shoreline L
SAV:
Moratoriur
Photos:
Waiver Att
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
V 4�
Agent or Applicant Printed Name
i
Signature "Please read compliance statement on back of permit"
Application Fee(s)
Check #
No71648 A
Previous permit #
Date previous permit issued
L::] Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
B C D
Subdivision >
City ---—— - - ZIP
Phone # ( 1 River Basin
Adj. Wtr. Body _(nat Iman /unkn)
Closest Maj. Wtr. Body
(Scale: / )
See note on back regarding River Basin rules.
Permit Officer's Printed Name
Si
Is 7,n/�� xpiration ate

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)
(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: 0'J'j1 m C �q'0
Mailing Address: Pn►�eSYe
'1o�e l ��
Phone Number: �5 " —] L�
Email Address:
I certify that I have authorized )(A M F) �( 16 0 S(U =IbI r'I KS
A ent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: re ,2lace '('/ 5 h�
�OL/ 5F DIOC:lL p to, f, riv► �7/1-ry J�- a /,ori.� -
at my property located at
in r County.
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:
Print or Type Name
Title
Date
This certification is valid through
RECEIVED
AUG 0 8 2018
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Aty) C-) 's
_ (Name of Property O er)
property located at
(Address, Lot, Block, R ad tc.) qq
on , in p r d-t , N.C.
(Waterbody (Cit /Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iodation
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
r C f Vary. s +i (1 30 (f s C d D a"- E( P to d 1- n"
Lkjc L - ae*) s oLf sc do c- 0 � i a4 knvn 1 n \1 r S �� l
irzo4yy-i lc4 ,
RECEIVED
AUG 0 8 2018
DCM-MHD CITy
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 15' setback requirement.
do not wish to waive the 15' setback requirement.
(Property Owner Information) _ (Adjacent Property Owner Information)
or
City/(��c�eo� (A-)
Telephone Number/email address
'(-d— )
Date
' pry iv rre nC �i'1 �A rC
Maill' cAddress
tir /`1C oQ S�
City/State/Zip
Tele nellNr email address
Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to , 1 1 ► 's
//� (Name of Property Own
property located at "I ' y---.
(Address, Lot, Block, Ro , etc
on MQ9 :S A,�_ , in t 'd>✓ , N.C.
(Waterbody) (City 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 rill in description below or attach a site drawing)
3 � 01E) (� 4 �Ia.�t'vm to
RECEIVED
AUG 0 8 2018
DCM-MHO CITY
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.)
6 8o wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
6?/I�& C--AY
SiMature ,
Pros- Ws- 6 ge e pe Name A14
min Ad ress
►t /State2l ( o� J
T ephone N ber / email address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
SigT re *
Print or Typi Name I
V 6 -0-h
Mailing A dres
City State/Zip
�—�a- 7
Telephone Number/email addr s
R'-1 - I -R'
Date*
(Revised Aug. 2014)