Boger Jr, James

CAMA / DREDGE & FILL NO 71386 A
GENERAL PERMIT Previous permit #
-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 SA NCAC
Applicant Name Project Location: County
Address `, Street Address/ State Road/ Lot #(s)
City --- State — ZIP
Phone # () _ E-Mail Subdivision
Authorized Agent City_ ZIP_____—
Affected ❑ CW [II EW PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body --__
Type of Project/ Activity
(Scale: j )
Pier (dock) length
Fixed Platforn
Floating Platfc
Finger pier(s)
Groin length
number
Bulkhead/ Rip
avg dicta
max dist
Basin, channel
cubic yai
Boat ramp
Boathouse/ Bi
..._... _...._....__.
Beach Bulldog
Other
Shoreline Len
SAV: n
Moratorium:
Photos:
Waiver Attacl
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
t
'Age o�Applicant Printed Name
Signature "Please read ro lance statement on back of per
/ 711.
attached.
B C D
See note on back regarding River Basin rules.
Permit Officers Printed Narrme
Sig tue
Application Fee(s) Check #
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 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 L 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 (252-946-648 1 ) 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 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 FORM FOR PERMIT APPLICATIONS
T�rn�s �.
Name of Property Owner Applying for Permit: B06640-
Mailing address: 1 2 16 SEp, GAM -L)�ZVIL
VitypnKi' , /Vole))y C iVOLIWA
Telephone Number: (D�� 39 -3cf q
I certify that I have authorized �12 C�LS�D� �i�t�i-U`� (agenVcontractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of .L/iip,P©G,►'J� Q� �7CJ6
at my property located at 12 16 -'5m Gvg Ag-ryt /I�,wA!qeT Al
This certification is valid through (date).
(Property Owner Information)
-Ys 6a�
Signat4re -
Print or Type Name
f ie0/4iy &Nge
Title, co. owner or trustee for property
z3jut 7D18
Date `
(749) 938 8V9�l
Telephone Number
Email Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 'j.. Mes L. lJ Me J 's
(Name of Property Ow er)
property located at r 2 SM GAM Diept , /14 pp ' (1412,0
1 (Address, Lo Block, Road, etc.)
on r�� R K CZ'�'�v, in I'W,49eT (64494 ) , 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.
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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 give the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner In rmation) (Adjacent Property Owner Information)
iguature Sign(vure
El'1V1 D��� SIZ. A-5- 11y
Print or Type Name Print or Type Name
L J /y0 8 S-- (per Er
M t ng Address Mailing Address
=Pne ", AJ6 09 N pr��T ZBS j
Cit /State t !Zlzip
% e )� g 3�95� . zo 3 .Z/sue
Telephone Number Telephone Number
Z3P4 20/8 a.Ly Z- _7 / ag
Date Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
herebycertify that I own property adjacent to ,
Y P P Y 1 J��S � &5� jrie� ,S
property located at f Z 16 S ame of Pro ertOwner)
�+ �� /��� (Address, U?o , Block Ro d etc.)
on ( ( in /''R� �C��T� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to this proposal.
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)
1 nV P&temlfAr o/- , irN6 509- a,Rx-t-
O00
WAIVER SECTION
understand that a pier, dock, mooring pilings, 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 ve the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
(Property Owner I rmation) (Adjac5nt Property Owner Information)
l J tA7✓1�5 J.
�P ure SignpAT
�, hee ✓�-�'f' /✓f , j✓y%r//
Print o Type Name Print or Type Nam
I Zf / z 2 `i
M i ing Address Matltn ddress
Citylstate-271D CitylState/Ztp
Telephone Number Telephone Number
2�/L 2O/S
Date Date
(Revised 611812012)