73155

CAMA / DREDGE & FILL✓
No.
73 155 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 15A NCAC t
`
�
Applicant Name
Project Location: County
ea L� Rules attached.
t A (/ 6 AJ
Address r ,.f .1y r'r , ,,I
/C Street Address/ State Road/ Lot #(s)
City—. State r ZIP
S (
Phone # � �� t
( ) _ E-Mail
"#Subdivision
7
Authorized Agent
City �� :%
ZIP 2-k5?'//6
El CW L(PTA EKES El PTS
"
� w!r 1C -
Phone # ( ) �.
,IGI ,r" River Basin ; e—,
Affected
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body P.?tr`"'
(oat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / nl'o0
Closest Maj. Wtr. Body
-
Type of Project/ Activity/ �;
r�l',� t� a �r OF -ICI
r�%rt; •.aai
r, I IV o *J y
kiA 1`� 1i f
(Scale: 1 1 / " , )
Pier (dock) length r�r_
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore ✓'
4 r Amax distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other 5.S ttp3t . S
4,A,1
Shoreline Length
i
SAV: not sure yes nA - --
Moratorium: n/a yes , ct
Photos: yes - - < -
Waiver Attached: yes no
A building permit may be required by: t[ ve")
( Note Local Planning jurisdiction) t
Notes/ Special Conditions 0 r". �9 7t 11 ty) j" ,
+f , !
V.JI LC 1 ,4\ri r. VJAk
Ar licant Printed Narpy<{��,
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
h See note on back regarding River Basin rules.
r
01. -3 r,/ f✓cc i 3 3 !% r�'f
c.
Permit 0 icer rioted Ne
4 7�tr.
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
landowners).
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 _I 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/ 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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that.I own property adjacent to W ii-4 i A m F: wAKfl
(Name o Property Owner)
_...__.___..property.loca'�ri-at.ZNSoz- ©14 CJ-,�r ;f eral Win.-
(Addres,LLot, Block, Road, etc.)
on L\Je_yf?C K1 Jew , in .C' QAVCY-) e.v. N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatior)l, -
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)
G©nC-0-CT'C at4Lr+� -I-t*A_0 ATrAc_4rN6JM6"T-rA3e6 To
i�E t6 r4 P�dQ'S PylAl.k wOW ElCTEAID ifJC— APpi2A,— 13o' iL10 t
Jf '�j AtK P I L L. W t T}{ t X '}j'l N Ea R 1 RA P F t LL F 21 A L
`�/ tn►LD A CnNL�;� C10 % NLo�k �' E"i �cN,t�j`c, wh�� ,4 T CAI � F
5tDE o V-I LL + afte-l<FIL.L LAP Td y o LOVE-1- To
f` o pc L.11qe: To -Fke So v%T*FAST
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
1� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner
-Signature
W I LL.J A.— F': V14& ,D Jrr
Print or Type NaTe
M fling A dress
city/State/Zip
2s;-2 ^ 6-ro - _N
Tele hone Number
v, �1 S
Date
(Adjacent Property Owmgr Information)
Signature
Print or Type IIa�Alexei Ku6
Mailing Address 2800 Old Cherry t Rd
City/State/Zip
New Bern NC 28560
Telephone Number
Date
252 2690174
(Revised 6/1WO12)

Brownlow, Roy
From:
Alexei Kuznetsoff <[e-mail]>
Sent:
Thursday, November 15, 2018 1:56 AM
To:
William F Ward
Cc:
Brownlow, Roy
Subject:
[External] RE: permit info and signature
Attachments:
DOC143signed.pdf
Hello all,
Please find attached signed document.
Kind regards,
Alexei

Brownlow, Roy
From: William F Ward <[e-mail]>
Sent: Wednesday, November 14, 2018 9:00 AM
To: Brownlow, Roy
Subject: [External] FW: Scanned from a Xerox Multifunction Printer
Attachments: Scanned from a Xerox Multifunction Printer.pdf
CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an
attachment to Report Spam.<mailto:[e-mail]>
Roy,
Here is my information and "application for permit". You should receive the adjacent property owners permission
documentes directly from them today, if you haven't already. After you do your site visit, let me know if you need anything
else and I will happily provide it to you. I will run the application fee down to your office probably tomorrow morning.
Thanks for your help in fixing the mess left by Flo.
Bill Ward
-----Original Message -----
From-, [e-mail] [maiIto :[e-mail]]
Sent: Wednesday, November 14, 2018 4:53 PM
To: Ward, Bill
Subject: Scanned from a Xerox Multifunction Printer
Please open the attached document. It was sent to you using a Xerox multifunction printer.
Attachment File Type: pdf, Multi -Page
Multifunction Printer Location:
Device Name: XeroxC8030
For more information on Xerox products and solutions, please visit http://www.xerox.com

Brownlow, Roy
From: Kent Flowers <[e-mail]>
Sent: Wednesday, November 14, 2018 8:28 AM
To: Brownlow, Roy; [e-mail]
Subject: [External] Permit Consent Form -William F. Ward III
Attachments: Permit Consent Form.pdf
If you need additional information you can call my cell at 252-617-9037.
Thanks, Kent

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to W tLt. rAm F. 1W #40t1J. IV is
1Nama of P.rocerty Owner)
on
The applicant has described to me, as shown below, the development proposed at the above
locatiorLr
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)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 I
W ILL.{ grrY+ P': vq ela .in`
Print or Type Narpe
zo'-Z'
MI1t Address A' Zg
lClty/ atamp
Z 'z -7V 47o
Tel hone Number
Z
Date
(Adjacent Property Owner Information)
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30 D Sc ,-��� .
Mailing Address
-Ale- I..r.Ae- Y-�iyL72-$ �60
c,'tylstateMp
25-2— 6 (:Z
Telephone Number
14 20 t 9
Date
(Revised 6/1&2012)

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