Marshall, Randall

r. �4 CAMA / Q DREDGE & FILL No 71696 A B C D
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El 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 I SA NCAC�fi t . d j `�
Rules attached.
Applicant Name
'
=Z�Addressi
W
State_
City
Phone # �) '' ' SAE -Mail
Authorized Agent
V "' j - ;
❑ CW
D EW ❑ PTA ❑ ES
Q PTS
Affected
❑ OEA
ElHHF ❑ IH ❑ UBA
❑ N/A
AEC(s):
❑ PWS:
ORW: yes / 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 lengt.
avg distance offshore —
max distance offshore,
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bul
Other ,
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction) �y
Note Special Conditions 7
Agent or
Project Location: County
Street Address/ State Road/ Lot #(s) '' r< i' .y✓# -;+ ,i
- i
Subdivision
City ZIP ...,%
Phone # ( ) River Basin
Iro
Adj. Wtr. Bodyt(/man /unkn)
Closest Maj. Wtr. Bodyf:.
(Scale: .i
rn r o Cof t T f See note on back regarding River Basin rules.
Sign a re "Please read compliance statement on back of permit"
("? -�?i, ZI
Application Fee(s) Check #
LIP
Permit Officer's Print Name
/
Signat re
/ /
Iss ng Dat 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 - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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
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 FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: Raja U C-.
Mailing address: -J7 i'Ttdr hVL C1 Ir
1,604 1 c
Telephone Number: q)q-q37- VR70
I certify that I have authorized-IntLLL.m3 ham_ (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of i tis'a �j.' �P 3
at my property located at
;-UYLS-
This certification is valid through d - a 9,! 4 (date).
(Prop" Owner Information)
(p4v4ae n mja��
Signature
Print or Type Name
Title, co. owner or trustee for property
5-aq-tt
Date
lq i `m -- 1�q'70
Telephone Number
nv4mrn ra-) bVC ISOV ' o
Email Address

r
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U.S. Postal Service"'
CERTIFIED MAIL'RECEIPT
1 Domestic Mail Only
C
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cr
1041110led Mail fee
$
Extra ServToeff OL rees Pea box, acid *11
0 Return Receipt (ha d-PY)
0
0
Re— Receipt (—c)
❑ Ceirtfled Mail Restricted DaVety-
C3
❑ Adult 8W-m Fmq—
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Postage
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For delivery information. ViSit OLP VlObSltO 3t lVk%T,',11SpS,CO?1?
BAY
r --rHW Mail Fee
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$
Cr t:x" semoos & fees W" box, &W
El Rotum Receipt (hardcopy) $
C3 Fj Retum Receipt (electronic) $ Postrywk
r3 [I CertifiloW Mail Hestrioted DeNM $ Hers
0 JINhIltSignatueRequired $
1, I Adult Signature Restricted Delivery $
L—J Postage
Ln W. A9/11 /2018
150 paiii. ia Fees
$6.91
.............
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■ Complete items 1, 2, and 3. a
Agent
■ Print your name and address on the reverse X ❑
so that we can return the card to you. ❑ Addre
■ Attach this card to the back of the mailpiece, B. Received by (Pont ) C. Dat o eli
or on the front if space permits.
1. Article Addressed to:
/n/. -L/4/5. Grakq v..._ R If'
9 lv C--1,"L S+..
V a vN 4LQ ► v,, r-e, ,j'c 3A
D. Is delivery address diffe from item 1? Yes
If YES, enter delivery address below: ❑ No
3. Service Type ❑ Priority Mail Expresso
II I IIIIf I IIII I'I I II I III'II III I IIII �II�I I I III ❑ Adult Signature ❑ Registered MailT
Q Adult Signature Restricted Delivery El Registered Mail Restricted
❑ Certified WHO Delivery
Q Certified Mail Restricted Delivery ❑ Return Receipt for
9590 9402 3893 8060 0254 77 ❑ Collect on Delivery Merchandise
Q _ {m , ,v_ __ _.. touwccnn nrdivary Restricted Delivery Q Signature ConflrmaticnTM
2. Art ❑ Signature Confirmation
7 017 1450 0001 9377 4167 Icted Delivery Restricted Delivery
(over-
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

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