Saylor, Scott

CAMA / DREDGE & FILL No. 73321
^ A B C D
GENERAL PERMIT Previous permit#
-
New Modification Complete Reissue r_ 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
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP t '
Phone # ( ) E-Mail Subdivision
Rules attached.
Authorized Agent City ZIP
Affected ❑ CW E EW PTA ES PTS Phone # ( ) __ River Basin
AEC(s): ❑ OEA C HHF IH UBA N/A Adj. Wtr. Body _ _ gnat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body --
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 offsh i
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length I ; '
SAV: not sure yes no -- - �
T i
f—
Moratorium: n/a yes no
Photos: yes no' --�
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale: , )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature '
Issuing Date i iratio to

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 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/ 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: I LE'l-1 lgox- D 0
t, r-ocr N 273 S l6
Phone Number: �') I� ) Z 17c7
Email Address:
I certify that I have authorized t✓ Q��� �>21
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: VE b'1' 1 d '-De ':�k
at my property located at I ,
in
County.
1 furthermore certify that 1 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: RECEIVED
NOV 2 7 2018
Signature-1 DCM-MHD CITY
L'. #- /I '-54 '-/ /0 r--
Print or Type Name
Title
Date
This certification is valid through I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOA TLIFTBOA THO USE) /
I hereby certify that I own property adjacent to St-4a( i raK.c l f SCE y (�.�- 's
(Name of Property Owner)
property located at
113 L,
KA.+1C % U4 I',—�
(Lot, Block, Road, etc.)
one S �L , in �a►. , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: q f't - S $l - Z l '7O Mailing Address: l t �.t,Hsxv,%�i, Po
r?Qa..✓� N C 2 ? S (�
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
V I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
j 4Q Z �,,-4 i RECEIVED
NOV 2 7 2018
DCM-MHD CITY
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) J ,
Mailing Address
&,r �W -- . N C.-- .2 t (o
City/State/Zip
ft^1 - R/•,;i-7o
Telepho N mber
rc �
Signature ate
Signature
e
Print or T e Name
Telep one Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 11t9. �a�wi� s
(Name of Propert Owner)
property located at 3 �4i� t.-t (, 1' 0 ( 1 l(-o 6 et
(Address, Lot, Bk, R a)
onC�r-uk
�
, in Z
( aterbody) (City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location
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)
�ED�IV�D
2 7 2018
DDM-MHD Ciry
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.)
CR
�� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop9hy Owner I ormation) (Adjacent Property Owner Information)
xJ
M ,
Print or Type Name nQ Print or T pe N k ` 'I ` �—O— T
Mai)�AAddl A (C �S/ L M Address -f
City/ at Zip City State ip U
Telephone N ber email address Telephone umber/email address
rl I �l /y
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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