Abroms, Ricky

NP 71392
/C D
i CAMA / ❑ DREDGE & FILL
A
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GENERAL PERMIT
Previous permit #
-`'New ❑Modification LiComplete Reissue - Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
7P 1
and the Coastal Resources Commission ' n area of environmental concern pursuant
to I SA NCAC
QRules attached.
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Project Location:
County C-Y
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Applicant Name
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Street Address/ State/ Lot #(s)
AddressI_ij
- 4ICZIP? f
State '
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City.
-
Phone # f't�
(_ —) ' ' "I E-Mail __
Subdivision
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Authorized Agent
City- f ' ' '
ZIP
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❑ CW V C7 Prr TA El ES ❑ PTS
Phone # O
River Basin
Affected ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
AEC(s):
Adj. Wtr. Body
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?� �'�
(nat /man /unkn)
❑ PWS:
Closest Maj. Wtr.
Body ,
--
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) © X
Floating Platform(s) --
Finger pier(s) L) '
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards _
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
Shoreline Length
SAV: not sure yes no,
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
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Agent or Appl'c7nt Printed Name
A.
Signature "Please read compliance statement on back of permit"
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Application Fee(s)
Check #
o
(Scale: ,,V , f )
See note on back regarding River Basin rules.
Permit Off rin [Name
l
Signature >
Issuing Date Expi tion 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
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

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DATE ' b - 12- 19.
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to s A -,A 5 R ICIC Y At312" s 's
(Name of Property Owner)
property located at 8 31 r51AstcL Rd HAR 14tEeS _r,79 (At lb rl C..
(Address, Lot, Block, Road, etc.)
on GK soytilci , in HAR.KI;RS S-StA+Jcl, r4R,f.Co• , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. s
�Z 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)
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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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
S' 1[lttire
Ptin or Type Name
/5e'DS' /�—_i9�rN 3�0�lsT G�f•2[�
Mailing Address
F,oyE7roPs A.I.C, O
City! tate/Zip
" _ 3�0 'Y - oa 99
Telephon Num er I email address
l _
Date
*Valid for one calendar year after signature*
(Adjace Property Owner Information)
Signature
GR.4t 6, P e_A1,,V/S
Print or Type Name
'7[ZZ CANAL Pr_ .
Mailing Address
,tF• 16ZAf-o Arc. a8s9
City,§tatelZip
aSa. - ?,/I -
Telephon Numb /r iDemail address
Date
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to s
property located at 8 32, rs[A wk R4 (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on AC4� Sbulib in AAR9ek5 isGtuD . &IC N.L.
(Waterbody) (City/Town andtar County)
The applicant has described to me, as shown below, the development proposed at the above
iocati
I have no objection to this proposal.
I have objections to this proposal
DESCRIPTION ANQIOR DRAWING OF PROPOSED DEVELOPMENT
;individual proposing development must flit in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grain
must be set back a minimum distance of t 5' from my area of riparian access unless w2ived 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_
V, I do not wish to waive the t 5' setback requirement
(PropertyOwner Information)
t.s,.r�t^czture
.J e4►nC3 t fJr[ a� %4az ALL
Pr,ni or Type Name
lq�S Ferry a4ptrtsr c ff. kC'.
Mailing Address
A�rcre.rrO ps Ate �'i i3 6
cit ylstate/1ip
025-12__� o --oa99
Telephonr- Num�rlemail address
6 /Ig /IP
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Print or Tyne Namb
Mailing Address
y/srae2,p
S.Cowl
Teleph ne N nTber l emaii address V w�c
i:172
Revised Aug. 2014)
*Valid for one calendar year after signature*

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _TAeA S R tCKY ABRAAAS
Mailing Address: L40S s D
ItuertQPs,4C 221$4!16
Phone Number: 2 5'2 -- 50 q — O Z 99
Email Address: ICKV @/W6rfr"r-10 1-
ievrL�R�aRs oil
I certify that l have authorized 00 it,('&/,4
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: _ 0QCK RCPzAccmc6(r
at my property located at e 3 Z U Rk�=PS 1'51 RN,D
in CARECP& I' County.
I furthermore certify that / 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
R!Cle 'saAiws
Print or Type Name
Title
Date
This certiftcation is valid through I I