Bader, Robert

-CAMA / DREDGE & FILL N2 71642 A B GC 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 15A NCAC !
% ❑ Rules attached.
Applicant Name y� C°pf T f Project Location: County t
Address ? 1 4 Street Address/ State Road/ Lot s)+
City_ ci ' State �� ZIP 6 � � � �
Phone # )11 �` Lo E-Mail Subdivision
Authorized Agent Y Cityt`r,' r. ZIP 1
Affected ❑ CW LAW ,ETA Lt�llff ❑ PTS
AEC(s): ❑ OEA HHF ❑ IH ElUBA ElN/A
❑ PWS:
ORW: yes / no ? PNA yes / no
Type of Project/ Activity
Pier (dock) length ✓" t��t
Fixed Platform(s) u� f
Floating Platform(s)
Finger pier(s)_ t
Groin length
number
Bulkhead Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozi
Other
Shoreline Length 7-2 4
SAV: not sure yes no
Moratorium: n/a yes n
Photos: yes no
Waiver Attached: (yes '
A building permit mayte required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
i A, l fir.
Agent or Applicant Printed
■+Name
Signature ** Please read ompliance statement on back of permit
Application Fee(s) Check #
Phone # ( )_� Ri r Basiny T' Ur
Adj. Wtr. Body l Uk-k- ,' . --/ na man unkn
Closest Maj. Wtr. Body
(Scale: 4 T )
See note on back regarding River Basin rules.
;71-
'J ) "-'
PermitOfficef s Printed Name '
Signs ure
R i
Issui g Da e E piration Date

e
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)
a I
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 Owner Requesting Permit:
Mailing Address: q �) (v �
Phone Number: 2-4-v
Email Address: �%J co-1 LAC) . h LV-4nCa0 -, ►'�
I certify that I have authorized L,o-rry k �� rto �C� �T, jM a�rnp
Agent / Contractors c,
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: � o� t)e W��-
4 40
at my property located at -e
in `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.
Information:
Signature_
Print or Type Name
Title
�l �l
1�
Date
This certification is valid through I /
IqECF-IvEb
JUL 16 Z018
pCM-MHD CITY
cr-el-e,

A
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l2C'`-zc (+ � Pzt vv,
�1 (Name of Property Owner)
property located at/��
(Address, Lot, Block, Road,
on C ti in N.C.
(Waterbody) (City/Town and/or County)
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.
e_... ___ __ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
11 ro !10 5J
pc� C r,
pjp��i
WkIl
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 �aived by
me. (If you wish to waive the setback, you must initial the appropriate blaqoQubGv.)
I do wish to waive the 15' setback requirement. C,
I do not wish to waive the 15' setback requirement. M�
(Adjacent Property Owner Information)
ze6;L
Signature*
(1Le- �-�
Print or Tye mp
2� `�
Mail' Ad dre s
- 14StSA'p
- (. 20 �t2,Pb
Telephone N ber%email address Telephone Number/email address
61S/��� i91
Date Date*
Aug. 2094)
*Valid for one calendar year after signature*

•
ADJACENT RIPAR[A N PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to
Property located at (I1iaa�e o� P
n / roperty Owner}
On ( l-'�,! (AddYeSs, mot, a oc,c, Road etc.}
(lrtiaterbody) —' in �✓ �ti Lt"
(CitylTown and/or county)
' N C.
The applicant has described to me, as shown below, the development proposed
Iocation p p sed at the above
have no objection to this proposal.
I have objections to this proposal.
`-"v'•°�, !ULM AND/Old DRAWING OF PROPOSED ©EVELOPt14EN
o osir�ri de�ef L artLFsf fill lrs descriofion .below or attach a site drawing,
rJ<� p�ep,�q s�w,ii ��e D�e
GGc� �J�il I
I understand that a pier, J0crI, mooringr
must be set back a minimum distance of pi
from my area of riparian access unless waive
i , or groin
me. (If u wi h to waive the setback, you mus i�,itia) the a ro r►ate bank below d by
me. (if
pp p� C�
I do wish to waive the 15' setback requirement. �E
— I do ?ot wish to waive the 15' setback requirement.
(P
vvvi:Gt mrormatton)
71
or
FpSName !
Cit v'St to i
T elephone Number/ email address
.hare l d
Naiid for one calendar year after signature`
,Adjacent
Fri
�vL
Owner In$ IOn}
Ke —
Nr! i or Type Name
� Ad ss.
CifY /Zip
Telephone I/y�umerrmaii address
Date' `
(Revised Aug. 2014)