Hall, Robert

CAMA / ❑ DREDGE & FILL NO. 73346
GENERAL PERMIT A B= D
Previous permit #
New Modification ❑Complete Reissue EPartial 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 f en i onmental concern pursuant to 15A NCAC_
i ❑ R es attached.
Applicant Name , r r /` Project Location: County
Address # if Street Address/ State Road/ Lot #(s),
City if c' -' State ZIP—o)
r b
Phone # ( ) J* j.,,sl, •�
� E-Mail Subdivision
Authorized Agent City
Affected
CWPTA ❑ ES ❑ PTS
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes",,/ no PNA yes f no.
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) .
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 Bulldozing U
Other
I
Shoreline Length
SAV: not sure yes o
Moratorium: n/a yes o
Photos: es o
Waiver Attached: yes no f
A building permit may a required by: C_.- yP''✓�
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Chick #
Phone # (_— )
ZIP
River Basin
Adj. Wtr. Body (nat _Lan unkn
Closest Maj. Wtr. Body
(Scale: /'J i
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
C..
Signature
`7 ;
Issuing Date xpi tion Date
F

J
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
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/ I-888-4RCOAST
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)
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)
http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17

11/29/2018 23:25 3366290396
VA
PAGE 01/01
�I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own properly adjacent to
property located at (Name of Property Owner)
(Address, Lot, Block, Road, etc.)-
on .�.1�I-�G� Sor��v� in �,�{.gkEw C i t , N.C.
(V1/aterbody) �! (City/Town and/or County)
The applicant has described to me, as shown below, the development pro�s
locati sed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP{ ENT
(individual proposing developmenf must fill in description below orattach a site drawing)
P1' r"< ,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15from my area of riparian access unless waived by me. (if you
wish topwaive
ythe setback, you must initial the appropriate blank below.)
—/✓ �. 'Wo wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property owner information)
Si2wture
Print or Type Name _
/r'•Ur 7�vac' /�S
MV,fing Addross
zf9q6&_s ) J *' C. !
Qvstate/Lip
Telephone Number
!WTr
Si
Print orlType Name
;9-S 17
Meiling Addrew
f-tshel c�r� 1VC -27, 0Q
CrtyyStateMp
Telephone Number RECE1v ED
__If_ _�P1- 1
r
h����(� 0 2o�a
(Revised 6l1 L� 01112 CITY
QGM_MND