Williamson, Larry

�J CAMA / 'DREDGE &FILL f ' � 11 i ` p i (No. 73134
A B C D
GENERAL PERMIT Previous permit #
EINew ❑Modification ❑Complete Reissued DPartial Reissue Date previous per 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
❑ Rules attached.
Applicant Name ' - Project Lo4tion: County----.—
Address
( , I /, �,,! Street Address/ State Road/ Lot #(s)
� ,- •� �;• � -�
City_
Phone # (_)
Authorized Agent
Affected ❑ CWEl oEA
AEC(s):
❑ PWS:
ORW: Yes / no
State LA_ ZIP
,. 7
-- - II
❑ EW [)�UA t ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
PNA yes / no
t` Agent or Applicant Printed Name
y.,
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Subdivision
city ' ZIP_.
Phone # / �' ' ver Basin
Adj. Wtr. Body / nat man /unkn
Closest Maj. Wtr. Body `' f
Permit Officer's Printed Name
Signature
Issuing Dat Expiration

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 E 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

SEA? i �U�'�- OKRA i i O] 'FG °Y
Date / 0 - 13-153' �vEo
RVCF
dame of Property Owner Applying for Permit:
/ ®C ,MHD G�TY
—7
Mailing Address:
S &,VA- Ball" La-� v art
5'IYSSti
I certify that I have authorized (agent) TtL lf.Lv• to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) &,id Qre,14 ,
at (my property located at) otd A Ire e b2. Jatic AN0 ,� NC.
�j-OAj 0AIWA/;'i
5A,ve F lereAe r
This certification is valid thru (date) /I -- 31 --/
Property Own/Signature V Date

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