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GENERAL -PERMIT' 0reviou­,.p6anii#.:`
EJ C& pIete Reissue' D Partial Reissue Date previous -permit issued
As authoriz6clby 66 State of North Carolina, Deipartment,of Environmental Quality
and the Coastal Resources Commission in an area of environmbntal,,c-oncern pursuant to I5A-NCAC-
[Rules attached.'
Project-* Location: County,
Applicaht Name
!,4=,C), Street Address/ State Road/ Lot #(s), 04��
P State
'
-city 1�� I !�� -, "
at C, ZIP 'RA 7 y i z--%d 42
Phone # H q — S-439f� F-A
E-Vaill
Authoriied,A t M:&P�v City ZIP 2_­7
Agent ty
0 CW- �EW �,T'E�PTA­_ EIES EI PTS Phone.#-(" Riv�River;asin 0 OEA 0 HHF C-1 IH,': '0 UBA 0 N/A­ALC(s): Adj. Wtr. Bod ?4ri i_i t /man'/unkn
0 PWS:
Closest Maj. Win Bo
dy ORW:' yes / 60D PNA yes
/ Go
($calle: -Zo"
'Pier (dock)'Iength
',Fixed Plat . fcorm(s�-
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MONO
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ems'='���■: �■:■■■■■■■■■■■::�:��■�
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Ag nt plicant Printed'Nam6
,•,Signatur
PI
PIdea§e read comfoliance statement on backof permit
31 31
Application Fees) Check #
Rermit,Officer's Printed Name
Issuing Date Expiration Date,

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: W liVlaW1 A. aSSY1aGI
Mailing Address: _ ao C);a'oA N%ay\5 -�)Voje oak
�z�e:�g1n II L 21(Q 0 0t
Phone Number: 2521 4 01 - 2 'blbb
Email Address: 1oi11• a$$"ac1N* ma.'k• cows.
I certify that I have authorized bj %AA.,
, v Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:��
at my property located at
inCounty.
tJ U
I 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
U�1��U1.la A • T aSShay4
Print or Type Name
o u.) vie v'
Title
1 / I /
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to MWiaW1 A. FaSShaC14 's
(Name of Property Owner)
property located at k2t4 B t?NNik" 'Road baiK N L
(Address, Lot, B ocl k, Road, etc.)
on ?amu Lo V of , in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiW-
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)
t�01�0;k
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.
I do not wish to waive the 15' setback requirement.
Owner
Signature
W tWkam k . �asshac.
Print or Type Name
l210
Caws P�1bav�s Dyweyw�} (�I�q
Mailinq Address
Date
Number/email address
`7
(Adjacent Property Owner Information)
Signature C
Print or Type Name
Mailing Address 0
Ci tate/Zip
19 - Sao - +50 f
Telephone Number/email address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

SECTION .1200 — GENERAL PERMIT FOR CONSTRUCTION OF PIERS AND DOCKING FACILITIES: IN
ESTUARINE AND PUBLIC TRUST WATERS AND OCEAN HAZARD AREAS
15A NCAC 07H .1201 PURPOSE
A permit under this Section shall allow the construction of new piers and docking facilities (including pile supported or
floating) in the estuarine and public trust waters AECs and construction of new piers and docks within coastal wetlands
AECs according to the authority provided in Subchapter 07J .1100 and according to the Rules in this Section. This
permit shall not apply to oceanfront shorelines or to waters and shorelines adjacent to the Ocean Hazard AEC with the
exception of those shorelines that feature characteristics of the Estuarine Shoreline AEC. Such features include the
presence of wetland vegetation, lower wave energy, and lower erosion rates than the adjacent Ocean Erodible Area.
History Note: Authority G.S. 113A-107(a);, 113A-107(b); 113A-113(b); 113A-118.1; 113A-124;
Eff. March 1, 1984,
Amended Eff. July 1, 2009; April 1, 2003.
15A NCAC 07H .1202 APPROVAL PROCEDURES
(a) An applicant for a General. Permit under this Subchapter shall contact the Division of Coastal Management and
request approval for development. The applicant shall provide information on site location, dimensions of the project
area, and his name and address.
(b) The applicant shall provide:
(1) confirmation that a written statement hasbeen obtained signed by the adjacent riparian property
owners,indicating that they have no objections to the proposed work; or
(2) confirmation that the adjacent riparian'property owners have been notified by certified mail of the
proposed work. The notice shall instruct adjacent property owners to provide any comments on the
proposed development in writing for consideration by permitting officials to the Division of Coastal
Management"within 10 days of receipt of the notice; and, indicate that no.response will be interpreted
as no objection. DCM staff shall review all comments and determine, based on their relevance to the
potential impacts of the proposed project, if the proposed project can be approved, by a General Permit.
If DCM 'staff finds that the comments are worthy of more in-depth review, DCM shall notify the
applicant that he must submit an application for a major development permit.
(c) No work shall begin until an on -site meeting is held with the applicant and a Division of Coastal Management
representative to review the proposed development. Written authorization to proceed with the proposed development
shall be issued if the Division representative fords that the application meets all the requirements of this Subchapter.
Construction shall be completed within 120 days of the issuance of the general authorization or the authorization shall
expire and it shall be necessary to re-examine the proposed development to determine if the general authorization may be
reissued.
(d) Any modification or addition to the authorized project shall require prior approval from the Division of Coastal
Management.
History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124;
Eff. March 1, 1984;
Amended Ef . October 1, 2007, August 1, 1998; January 1, 1990.
15A NCAC 07H .1203 PERMIT FEE
The applicant shall pay a permit fee of two hundred dollars ($200.00) by check or money order payable to the
Department.
History Note: Authority G.S. 113A-107, 113A-113(b); 113A-118.1; 113A-119; 113-119.1; 113A-124,
Eff. March 1, 1984,
Amended Eff.' September 1, 2006, August 1,' 2000, March 1, 1991..
15A NCAC 07H .1204 GENERAL CONDITIONS
(a) Piers and docking facilities authorized by the general permit set forth in this Section shall be for the exclusive use of
the land owner, or occupant and shall not be leased, rented, or used for any commercial purpose. Piers and docking
facilities shall provide docking space for no more than two boats. Docking facilities providing docking -space for more
than two boats shall be reviewed through the major permitting process because of their greater_potential for adverse
impacts and, therefore, are not authorized by this general permit, excluding the exceptions -described in Rule .1205 of this
Section.
(b) Individuals shall allow representatives of the Department of Environment and Natural Resources to make inspections
at any time deemed necessary in order to be sure that the activity being performed under the authority of the general
permit set forth in this Section is in accordance with the terms and conditions prescribed herein.

(p) Piers and docking facilities shall in no case extend more than 1/4 the width of a natural water body, human -made
canal or basin. Measurements to determine widths of the water body, human -made canals, or basins shall'be made from
the waterward edge of any coastal wetland vegetation which borders the water body. The 1/4 length limitation shall not
apply when the proposed pier and docking facility is located between -longer structures within 200 feet of..the applicant's
property. However, the proposed pier and docking facility shall not be longei than,the pier head line=established by the
adjacent piers and docking facilities nor longer than 1/3 the width of the.water body.; .
(q) Piers and docking facilities shall not interfere with the°access, to any 'riparian property, and shall have'Ai mini um,`
setback of 15 feet between any part of the pier and docking' facility and. the adjacent property lines extended into the
water at the points that they intersect the shoreline. The minimum-setliacks,provided in this Paragraph may' be waived by
the written agreement of the adjacent riparian owner(s), or when two adjoining riparian owners are co -applicants; Should
the adjacent property be sold before construction of the pier commences, the applicant shall obtain a written agreement
with the new owner waiving the minimum setback and submit it to the Division of Coastal Management prior to
initiating any development of the pier or docking. facility. The line of division of areas of riparian access shall be
established by drawing a line along the channel -or deep water m front.of the property, •then drawing -a line -perpendicular
to the line of the channel so that it intersects with the shore at the point the upland piopefty:line meets:the ,water's edge.
Application of this Rule may be aided by reference to the approved ;diagram in Paragraph. (t) of this Rule: illustrating the
rule as applied to various shoreline configuration's. Copies of the, diagram may be obtained from the Division'of Coastal
Management website at http://www.necoastalmanag"ement.net. When shoreline -configuration is_sucli that .a,pe pendiculaz
alignment cannot be achieved, the pier or docking facility shall be aligned -to meet the intent of this Rule:to the:makimum
extent practicable.
(r) Piers and docking facilities shall provide docking space for no more than two boats (a boat is defined, ifij5A_NCAC
07M .0602(a) as a vessel or watercraft of any size or type specifically designed to be self-propelled, whether by engine,
sail, oar, paddle or other means, which is used to travel from place to place by water) except when stored on a platform
that has already been accounted for within the shading impacts condition of this general permit. Boats stored on floating
or fixed platforms shall not count as docking spaces.
(s) Applicants for authorization to construct a pier or docking facility shall provide notice of the permit application to
the owner of any part of a shellfish franchise or lease over which the proposed pier or docking facility would extend.
The applicant shall allow the lease holder the opportunity to mark a navigation route from the pier to the -.edge of the
lease.

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BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
ROY COOPER
. Govemr
MICHAEL S. REGAN
B RAXT0N DAVIS
Med
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico &
Neuse River. Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 02B.0233.& .0259. The
Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed -your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed, below. Failure to
comply with this Buffer Authorization may subject'the propertyowner and the party (contractor) performing the.
construction and/or land clearing to a civil penalty by DWR'of up to $25,000 per day per violation.
i. Crossing is- Perpendicular: Pier and docking facility access way most cross the 50 ft. riparian buffer
perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise -approved by DCM. The
alignment shall minimize"the removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials: All reasonable measures shall betaken to ensure the access way is made of pervious
materials like open -slatted wood or composite, mulch, or grass to meet the intent of the -rules to the
maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way. This
drawing will be used to aid in compliance and monitoring efforts.
• Pre -project site conditions: --
By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify
that all inform a
vtion rovide is complete and accurate.
`/." wet'd
Wicant0riciteANarne
or ADDlicant manature
GENERAL PERMIT
j r
P( cer's Signature
Issue Date
State of North Carolina I EnWonmental Quality r CoastalMmgement
Washington Office 1943Washington Square Mall Waslungtorr NC27889 r ZS2-946-6.4&
Wilmington Office 1 127 Cardinal Drive ExL Wilmington: NC 28405-38451 910-796-7215
Morehead0ty Office 1400 Commerce Avenue Morehead City, NC 28557 1 252-808-2808

Applicant: O t L t, t o nn
Date: 11 S -t- ee--x C3c3'` --Zo I
General Permit M- -7 Z 4,
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
y�
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