Trevino, Raymond

N
CAMA / ❑ DREDGE & FILL N2 7 161 1
A B C D
ENERAL PERMIT Previous permit#
6%ew [-]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
Rules attach¢d.
Applicant Name IF_ Project Location: County
Address f j
t
City I Li State / ZIP
Phone #`(� _Mail
Authorized Agent
ElCW ❑ EW '4PTA ❑ ES �❑ PTS
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) lengthy
i
FixedPlatform(s) L.'yii�")'`fLti�f�
Floating Platform(s) r
Finger pier(s) ! 1 Y
Groin length
number "
Bulkhead/ Riprap length �---
avg distance offshore
max distance offshore -..,--
Basin, channel ~'
cubic yards ----
Boat ramp_
Boathoussee/`Boatlift ,
Beach Bulldozing
v1 _
Other t�
Shoreline Length
SAV: not sure yes
I i
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
r
A building permit may be required by: M,
( Note Local Planning jurisdiction) +
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Street Address/ State Road/ Lot #(s)
t.dtl /
14-
Subdivision
City ZIP_
Phone # (!- _il� `! �iver Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature
Application Fee(s)
Check # 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 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-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 FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Ar91�►-�,,��Vim a
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
i Ir
- 5 -571 V `f L S r T-3 `f 7
1 z-q
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 / Z 6.f'w Ak
in County.
1 furthermore certify that 1 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.
ropetty Owner n ation:
Signature
Ziy_, end (L
Print or Type Name
Title
/ 2-
Date
RECEIVED
This certification is valid through _ _2I Z / / I JUL 2 6 2018
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to \A/O-rA Sr" Itk )S
(Name of Property Owner)
property located at i D r 1 'V p r J c- a g55 7
w s M e�r,Qa C� U N
on h(Address, Lots Block, Road, etc.)
Spooe.� 5
in r , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Mt*L
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)
seoe- t4t vA
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.
r information)
Print or Ylpe Name
i z-& 's
Mailing Adpress
Ar eAL6&W
Cit /State2ip
Telephone Number
7-z- IV -
Date
(Adjacent Property Owner information)
St aturre
to w,
Print or�.Type Name
P () t� ox 15 aL ]
Mailing Address
G ►-e-o- r V i` ( a, -7 S 3 S
CitylStatelZi
_ a5a��15a�a� � 1
Telephone N710
mber RECEIVED
`1,t43
Date
(L-"� arD)
UL 262018
(Revised 611812012)
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
on
(Waterbody)
(Name of Property Owner)
(Address, Lot, Block, Road, etc.)
, in
(City/Town and/or County)
I
N.C.
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)
S A,Pe��o
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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
Print or
Mailing Adaress
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Cit /State/Zip
_�- !t�s`S3�i
Telephone Number
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State2ip
cE�vE°
Telephone Number
Date
(Revised Np CY ,-V

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