Atencio

CAMA DREDGE & FILL No 71384 A B C D
GENERAL PERMIT Previous permit #
I New — Modification !Complete Reissue 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 I 5A NCAC
Rules attached.
Applicant Name Project Location: County_
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone #(_ E-Mail Subdivision
Authorized Agent City------ ZIP
Affected El CW [I EW Z PTA —ES PTS Phone River Basin
AEC (s): 0 OEA 0 HHF L1 IH .--UBA --,N/A Adj. Wtr. Body
E PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
(Scale:
Fixed Platform(s)
Floating Platform(s)
---
—
—
—
—
—
—
Finger pier(s)
—T
Groin length
7
N
-7
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshor e
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
�Tt
I
Other
7
-Alx
Shoreline Length
SAV: not sure yes r Patti
---------
Moratorium: n/a yes no
Photos: yes t no
Waiver Attached: Yes no
A building permit may be required by:Lam-See
note on back River Basin
( Note Local Planning jurisdiction)
Notes/ Special Conditions
regarding rules.
?Tff
or Applicant Phnted Name
Slgfftwe.- "Please re compliance statement on back of permit"
Application Fee(s) Check #
PermitOfficer's Printed Name
Signat rg,
7, 17,
Issuing Date Expiration 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, 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/ 1-888-4RCOAST
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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property p rtY Owner Requesting Kermit. IS2�
-P-1 NCw
Mailing Address:
Phone Number: 7-
Email Address: \moo �.t:��
`� �� y � c A
I certify that I have authorized /
Agent / 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 C SL�vjkyj County.
l furthermore certify that l 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.
roperty Owner Information:
f�
Signature
�u 1 �;;�,c�<-\-,)
Print or Type Name
Title
f J -)/ 0 / 7 Di A
Date
This certification is valid through -/-/

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT RE(aUESTED
I hereby certify that I own Property rty adjacent to
Property located at �'\\\ (Name of Property Owner)
J
(Address, Lot, Block, Road, etc.)
on a� ie in \\)
(Waterbody) _ N.C.
Agent's Name #: (City/Town and/or County)
Agent's phone #: Mailing Address:
He/She has described tome as shown below the development he/she is proposing at that location
and I have no- objections to the proposal.
----------------- ------------------------------- __ _ _ _
(in
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT _ M
dividual proposing development must fill in description below or attach a site drawing)
/fyou have objections to whatis being proposed, you mustnotifythe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice, Contact information for DCM offices is
available athttpJ/www.nccoastalmarravement net(web/cm/staff listinv or by calling 1-888-�4RCOAST.
No res onse is considered the same as no ob ectron if .ou have been notified by Cert ed Mail.
Information)
Pnnt or Type Name
�'�
Marling Address
City/Statal,,�p
k -7
!, a plumber/Ema4Address
\mil J L-
Date
(Riparian Property Owner Information)
.4-o-, �/-
Signature
Vc0
Print ur Typewame -
Mailing Address _
/%I`e U-)
City/StatelZip
Telephone Number/Email Address
Date
(Revised: Aug. 2014)

LtRTIFIED MAIL -RETURN RECEIPT REQUESTEWIM
D rvKm
I hereby certify that I own property adjacent to _
e
Property located at `'� l� 2 (Name of Property ty Owner)
(Address, Lot, Block, Road, etc.) ' onin
►� L
(Waterbody) - N.C.
(City/Town and/or County)
Agent's Name #:
M
Agent's phone #: ailing Address:
He/She has described to me as shown belowdevelopment he/she is proposing and I have no objections to the proposal.
p posing at that location,
-
------------------------------------- - --- --- - - -- - - ---- - ____ __
DESCRIPTION AND/OR D - - - - - - ---- -
DRAWING OF PROPOSED DEVELOPMENT --
(Individual proposing development must fi11 in description below or attac
h a site drawing)
If you have objections to ....... is being proposed, you must notify the Division of Coastal Ma
(DCM) /n writing within 10 days of receipt of this notice. Contact informat/on for DCM off'
available at :/ nagement
within
ement.net/web/cmistaff-listin orbyca/ling 1-888-�4RCOAST.
No res onse is considered the same as no ob action /f .o ices is
u have been notified b Certified Mail_
r Information)
���t � o
Pnnt or Type Name
v Qj �
Mailing Address
City/State/Zip
7 Q
Telephone Number/Email Address
Date
(Riparian Property Own r information)
Sign —
Print or Ty a Name
Mailing Address
*QlStateiZrp
Telepho4Numr/Email AddressZ
Date
(Revised: Aug. 2014)