Peretzky, Drew

CAMA / DREDGE & FILL
GENERAL PERMIT
-New -_Modification _Complete Reissue __Partial Reissue
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
Applicant Name
Address
City _
Phone #
Authorized Agent
Affected ❑ CW EW
ElOEA HHF
AEC(s):
❑ PWS:
ORW- ves / no PNA
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) f"
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length__
avg distance offshore f
max distance offshore
Basin, channel
State ZIP
E-Mail ---
PTA ES PTS
IH J UBA N/A
yes / no
cubic yards_
Boat ramp Oe`
Boathouse/ Boatlift___
Beach Bulldozing t .
n
Other
1
i
Shoreline Length '—
SAV: not sure yes
Moratorium: n/a yes
Photos: yes, n
1
Waiver Attached: yes'i no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
(, 4,,,
Signatu Please read compliance statement on back of permit
Application Fee(s) Check #
f1l
No. 73220 A
Previous permit #
Date previous permit issued
Project Location: County_
Street Address/ State Road/ Lot #(s)
Rules attached.
B C D
Subdivision
City _ _ ZIP
Phone # ( ) River Basin i(
t
Adj. Wtr. Body' ' ` ' ' (nat Yrnan /unkn)
Closest Maj. Wtr. Body'' l-
(Scale:�,f _
[J See note on back regarding River Basin rules.
T.
r�
Permit Officer's Printed Name f
n4a E iratio6 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 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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

From: Drew Peretzky [e-mail]
Subject: Re: Dock Extension
Date: July 24, 2018 at 11:02 AM
To: Brandi Robertson [e-mail]
Hi Brandi,
I am confirming that you can act as my authorized agent.
Please modify the permit request to allow for 4 pilings and a 5' width.
Thanks!
Drew
On Jul 13, 2018, at 10:08 AM, Brandi Robertson <brandiprobertson gmail.com> wrote:
Dear Mr. Peretzky,
Please respond to this email Confirming that I have permission to act as your authorized agent. This will allow me to obtain the permit on
your behalf for the dock extension.
I have attached the Notification Form that was sent to your neighbors. They have both signed and the returned the necessary form.
Please let me know if there are any changes or additions that need to be made.
Thank you.
<Peretzky Drawing.jpeg>
Brandi Prescott Robertson
B Prescott Marine Construction, LLC
252-249-0149
[e-mail]

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to 1� Ye Z 's
(Name of Property O er)
property located at I �,� C VC-C
_1 (Address, Lol Block, Road, etcn
ontrds ���eV-1 , in TOLM
()l D. , 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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fail in dbscription below or attach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, oathouse, 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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjace P rty 1 anon)
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Print or T peAlame Print or Type Name
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M Address Mailing Address
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City/S t City/State/Zip
l(� � 91�-?,zLt-(011
Telephone Number/emat7 address Telep a Iyurnberlernaft address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /' �e Zk- 's
(Name of Property O ner)
property located at I ��� ��� ��S I�� Y .
(Address, Lo Block, Road, etc. n
on & t��is C��e� , in GL ' Cc� l D. , N.C.
(Waterbody) kCityfTowfi and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
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)
McC(tkv �roper+Y
Qw?0 0
�ia� Sal
Qeve Iz�-Y
l�v�l�e
WAIVER SECTION
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 unless waived by
me_ (If you wish to waive the setback, you must initial the appropriate blank below.)
%' CA do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Telephone Number/email address
Dale
(Ad' cent Property Ownor Info ation)
4
Si pm�e{,
ELLC
P ' t or Type Name
Mai1)ng Add SS n , ,rl f� /I�!/
City/State/Zip
-671 7&
Telephone Number/email address
IV -f �17
Dale*
(Revised Aug. 2014)
*Valid for one calendar year after signature`