Faulkner, Samuel

—ICAMA / —1 DREDGE & FILL No. 73361 A B C D
GENERAL PERMIT Previous permit #
OlNeW ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 1r 1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Ru s attached.
Applicant Name ✓� t Project Location: County
Address+ r *- i Street Address/ State Road/ Lot #(s)�
City State Vc ZIP Ll
_.
Phone # E-Mail Subdivision_
__
Authorized Agent City ZIP
Affected ElCW DEW ❑ PTA ❑ ES ❑ PTS Phone # ( ) � iver Basi A t't
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): El PWS: Adj. Wtr. Body f ` " a Iman unkn
ORW: yes / no PNA yes / no Closest Maj. Wtr. Bodya
Type of Project/ Activity -1'±
Pier (dock) length_
Fixed Platform(s) A J_�f
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bul
Other
Shoreline Length {,1
--�--!--�—
SAV: not sure yes inMoratorium: n/a yesPhotos: yes
I
Waiver Attached: yes /no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale: Al % )
❑ See note on back regarding River Basin rules.
6
Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Signature
4
Ekpiration 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 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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
u' 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/ 1-888ARCOAST 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 PROPEcNT
RTY OWNER STATEME
I hereby certify that I own property adjacent to \ A LA- � -�- �1 A L.• -k e-- °s
1 (ame)of ,�PrIperty Owner)
property located at l z l) ) r _� �� -. k_, t,: A 11
` (Address, L tt, Block, Ro d, etc.)
on _�_ w�d,1(.u1�.,� 1r� l ��r������� in �Ji�;t `' 10644 N.C.
r_ ,
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to atiQn.
AC.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 rill /n description below or attach a site drawing)
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.
(Propert70ner Information)
'� d
Sig��r ure
Print or Type Name A:
Ma' y1bg' Addre�'
2�Zi.-Z z
City/ rete/zip
Telephone N mber/ mall address
i, �, e
Date
*Valid for one calendar year after signature*
(Adjacent Property
�Owner
�Information)
St'' at * 1
Print or T p j a gNt .�l
Ma"ing A dress F)
City/s ate/Zip
Tele hone Number/email address
Date *
(Revised Aug. 2014)

From: Davenport, Ryan !van.davenpoi ((,-)iicdenr.(�ov
Subject- Google Earth Image
Datc Mar 26, 2018 at 4:30:33 PM
T(. [e-mail]
Google Earth streams the world over wired and wireless networks enabling users to virtually go anywhere on the planet and see places
detail. This is not like any map you have ever seen. This is a 3D model of the real world, based on real satellite images combined with i
restaurants, hotels, entertainment, businesses and more. You can zoom from space to street level instantly and then pan or jump from
to city, even country to country.
Get Google Earth. Put the world in perspective.

DocuSign Envelope ID: 6C48AD90-4B46-4B57-AD9B-4CA18B6E518D
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to : > u - t' t'U�L hod �� is
'(Namee of t roperty Owner)
1
property located at e ��� �� ei` r' L--- K\�GriC
(Address, L k Block, R?ad, etc.)
on k �, , v1C ,4' -�K in :�� 5 �i' ' L� N.C.
(Waterbody) �— (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 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)
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.
(Property
yOOwner Information)
Sig�r/ ra e
Print or Type Name /
ai irig Addres
City/St t Izip f SS
Telephone Number/email address
Date
(Adjacent Property Owner Information)
_DocuSigU"d by:
Signatu * 57302 754CC .
Print ter Tyoe Name},,`` t
Mailing Addreps
City/State/Zip
Telephone Number / email address
12/13/2018
Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature`

DocuSign Envelope ID: 6C48AD90-4B46-4B57-AD9B-4CA18B6E518D
Davenport, Ryan
Google Earth Image
Mar 26, 2018 at 4:30:33 PM
[e-mail]
Google Earth streams the world over wired and wireless networks enabling users to virtually go anywhere on the planet and see places
detail. This is not like any map you have ever seen. This is a 3D model of the real world, based on real satellite images combined with i
restaurants, hotels, entertainment, businesses and more. You can zoom from space to street level instantly and then pan or jump from
to city, even country to country.
Get Google Earth. Put the world in perspective.

Davenport, Ryan
From: Samuel Faulkner <[e-mail]>
Sent: Monday, December 17, 2018 9:22 AM
To: Davenport, Ryan
Subject: [External]
CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an
attachment to Report Spam.<maiIto: report.spam(a�nc. )ov>
I
Sent from my Whone
1

Cannon, Amanda J
From: Samuel Faulkner <[e-mail]>
Sent: Tuesday, December 18, 2018 8:59 AM
To: Cannon, Amanda J
Subject: [External] Re: Agent Auth
Amanda , I give David Anderson with EZ Docks permission to pick up all permits for me, Thanks . Samuel Faulkner
Sent from my Wad
On Dec 18, 2018, at 8:53 AM, Cannon, Amanda 1 <[e-mail]> wrote:
Administrative Assistant
Division of Coastal Management
Department of Environmental Quality
252.808.2808 Ext. 200
252.247.3330 Fax
Amanda. Cannon(o)ncdenr.gov
400 Commerce Ave
Morehead City, NC 28557
<image001.png>
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
1