Flowers, Kent Jr.

CAMA / DREDGE & FILL NO. 73284 A
GENERAL PERMIT Previous permit #
New Modification 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 Rules attached.
Applicant Name _ _ Project Location: County _ - -
Address Street Address/ State Road/ Lot #(s)
City - State ZIP _
Phone # ( ) _ E-Mail Subdivision
Authorized Agent _ _ __ City - __ ZIP
[-ICW ElEW ❑ PTA A ES -❑ PTS Phone # ( ) River Basin _
Affected OEA ❑ HHF IH UBA N/A
AEC(s): ❑ El ❑ Adj. Wtr. Body _ � (nat_/man /unkn)
❑ PWS:
Closest Maj. Wtr. Body
ORW: ves / no PNA yes / no
Type of Project/ Activity
Pier (dock)
Fixed Platf<
Floating Plz
Finger pier
Groin lengl
numt
Bulkhead/
avg d
max i
Basin, char
cubic
Boat ramp
Boathouse
Beach Bull
Other
Shoreline
SAV:
Moratoriu
Photos:
Waiver At___..__.
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
AgApplicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
B C D
(Scale: ! t )
j
I
[YSee note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature/rl
Issuing Date Expi ionbate

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 I) 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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I( K, , ( 0 +-� z� ST- 's
T(Name of Property Owner)
property located at 3 b p S , � -�c .1-c- � IQ
(Address, Lot, Block, Road, etc.)
on e Y in LiuL., , I-, 'r, , nz�-4 , N.C.
(Waterb-ody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiory
1/ 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)
4-0
(31
�
�} oL ✓'c-.
u-A
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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
m . (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) (A face t Pro erty Owner Information)
1
Signature Si
Print or Type Name Prin or Tye Na
Mailing Address Ma ' ing dres ,
City/State/Zip Ci /Sta e ip
�-i 0 7
telelp` pne Nu�i er/email address Telephone Number/email address
z v t a. Ig
Date Date *
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _Kr►'rr-- h . +-�z `Ti. 's
(Name of Property Owner)
property located at = 3 b O S ;---�c � L,Q
(Address, Lot, Block, Road, etc.)
on �l/��,;c r�lt�e1� ,in Cfu_�cv�(nc'kL' —. N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiory�
1/ I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individualproposingdevelopment must fill' in description( below
\or attach a site drawing)
4-0
CL
C- Q
� �\ v�► �U
C—
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.� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requir Z
(Property Owner Information) ( e n t Pro a Info ation)
i
Signature
Print or Type Name
3 n O Sc :6
Mailing Address fn�
CAL✓�
City/State/Zip
('-) — el o 7
7-e/ephone Number/email address
,tl--VUg
FIB
*Valid for one calendar year after signature*
Signature
Print or Type Name
Mailing Address
-A/el'..' ge yj-
City/State/Zip
Z�2—C-1 tQ
Telephone Number/email address
/ /— Zv -/del
Date *
(Revised Aug. 2014)