Locke, Anne

J CAMA / ❑ DREDGE & FILL No 71652
A B C D
GENERAL PERMIT Previous permit#
❑New LModification ❑Complete Reissue El 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
❑I Rules attached.
Applicant Name r' Project Location: County_-_______
Address i Street Address/ State Road/ Lot #(s)
1{
1
City State � 1 ZIP + ` r
J
r_.
Phone # (_ _ ` I t -Mail Subdivision
Authorized Agent _ City ' i Al' ZIP
Affected ❑ CW ❑ EW IPTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length J A 1 �,.' (,
Fixed Platform(s)`
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel------- --
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
❑ ES ❑ PTS Phone #
❑ UBA ❑ N/A f
Adj. Wtr. Body 1.
Closest Maj. Wtr. Body
:r Basin
(Scale: _ )
Shoreline Length i 1 ! IN I I A I I I Ij
SAV: not sure yes no _
Moratorium: n/a yes no,,
Photos: yes no ,
�.
Waiver Attached: "yes no
A building permit may be required by: ❑ See note on back regarding River Basin rules.
( 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 #
Permit Officer's Printed Name
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 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
❑ Neuse River Basin Buffer Rules
❑ Other:
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
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

6DJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that ! own property adtacent to rt Nc�r�� , Lg
property located at�Fl-� N (1 (Name of Property Owner)
lir—
on CCU �� (Address, L t, lock, Road, tc.)
in N.C.
(WaterbodY) (Ci !Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
1 y�z�GKwQr �
I �
t'i'r 1 WAIVER SECTION I L�NG-
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 waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjace Property Owne mation)
S�gCe.�� Sign ut're
tqcF
Print or Type Qum l Pnf t r Ty Na e- ?
�' i � r " w � c _ � 7 =R�RcAzl tF
M g Addres¢ it g Address
City/State2►p 1 q �
'-' r -q 'r City/State2i
lu 7
Telephone Number Telephone Number
.04
Date Date N
(Revised 6118/2012)

aDJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that i own property adjacent to P Lp C
t 1 (Name of Property Owner)
Property located at L3k c�tv1 �
Q - _ (Address, L t, lock, Road, tc.)
on i q�FC� ITN Q 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
/E X/ ��U44, F
S
©,�,�`' Sc.��,•� � LINE
c.•N�' 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 waive 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 Information)
Property Owner Information)
7(Ad-ent
Z �� �
Si re
•
Si azure
C=6Jr�2LES L • Sr'yt rTtr Ug
Pnnf or Type Qum 1
Print or Type Name
c
M g Addre
"
yy I Z kA-Lo^),4
Mailing Address
�h
��u�rt,, Vl �2 70
City/State/Zip
City/State/Zip
Te%phone Number
Te/ephpneN mbar Fi
�.213/ri
Date
Date
(Revised 6/1 W012)

AGENT AUTHORIZATION FOR CAMA PERMIT -APPLICATION
Name of Property Owner Requesting Permit: 1�NNe-
Mailing Address: 4412,?c,wtc�rivC_.
mow__ e lU • G .7bt 3 -Z A l
Phone Number: 4
Email Address: oc�t . as i 3'�i am" .V . c-o^-"
1 certify that I have authorized �N�t Vl 4- b
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: -� X lelo
/'IlR
at my property located at 131 V4 N
in _ Cc�m�cr County.
I 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.
Property Owner Information:
Signature
Anr N t- -77 L ,j e,*<c
Print or Type Name
�yVNE R
Title
Date
is certification is valid through 12�J 31 / Zola