Randell, Benjamin

MA / ❑ DREDGE & FILL F1 J NO. 73303
A B CC D
GENERAL PERMIT Previous permit #
ew ❑Modification ❑Complete Reissue �_�Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality '%� 3
and the'Coastal Resour, es Commission in an area environ en al oncern pursuant to 15A NCAC /y
�`� P� � r/ � �� � � [ �/��Jles attached.
Applicant Name C f '1 I G G Project Location: County y "1 -"
Address r K )J c --, I Ir
City IM ` V C y State ZIP r
Phone # (;) / -Mail
Authorized Agent
Affected ❑ CVO E3t* VYA ❑ ES ❑ PTS
AEC(s): ElOEA HHF ❑ IH ❑ USA ElN/A
PWS:
ORW: yes �`no PNA yes / no
Type of Project/ Activity
Pier (dock) ler—k
Fixed Platforn
Floating Platfc
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg dista
max dist
Basin, channel
cubic yai
Boat ramp
Boathouse/ B4
Beach Bulldo:
Other
Shoreline Len
SAV: n
Moratorium:
Photos:
Waiver Attacl
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signatur� Please read compliance statement on back of permit
Application Fee(s) Check #
Street Address/ State,road/ Lot #(s)
Subdivision
City fv� ZIP f ~�
Phone # ( ) River/Bpin
Adj. Wtr. Body �PA LY ` nat man unkn
Closest Maj. Wtr. Body G G L'q ✓`
(Scale: Cw )
❑ See note on back regarding River Basin rules.
Sign ur
11(& 2
Issuing Date Expiration Dhte

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 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/ 1-888-4RCOAST 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)
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

Name of Property Owner Requesting Permit:
�N.J��l�►i� � �VD�GG
Mailing Address:
2 Z f �oSS�r� T/Ld
/J C -g S
phone Number: ZS"
Email Address: �J
I certify that I have authorized Pgent 1 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
in 6 0 P, —/l = County.
I furthermore certify that I 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:
� Are
—4*-Z
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V+WV 4 4.4-
Print or Type Name
Title
Date
This certification is valid through