Barrett, Bill

❑CAMA / ❑ DREDGE & FILL No 71391
GENERAL PERMIT � Previous permit # A B C- D
❑New ❑Modification ❑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 15A 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 ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ O.EA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (hat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body 3
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) u
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
t
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 L
Agent or Applicant Printed Name
[-]Rules attached.
(Scale: t )
[See note on back regarding River Basin rules.
4 j�
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check#
Permit Officer's Printed Name
Signatur g / d
f/I't
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/ 1-888ARCOAST 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
Name of Property Owner Applying for Permit:1�i
� n
Mailing address:
VA 1,2_
Telephone Number: ^ -, 9
I certify that I have authorized (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
S J
necessary for the proposed development of �-�i t�� ��-v� ( A�, ' J:r rQ CV^tea t
at my property iocated at aYI,,I t ,t v G ki Dki�GI-
This certification is valid through (date).
(Property Owner ii
Signature
Print or Type Name
--Zt-Lj -Title, co. owner or trustee r property
Date
Telephone Number
Finail Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T�l l l g t�-�"1U _b0.YV2.�' s
(Name of Property Owner)
property located at o��J�- StiwyC�.�h.e -I)V-.
(Address, Lot Block, Road, etc.)
on �t 1�l�eV , in 1�i1rC��9e-+mil . 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)
ex Is"ti Iq
--- 0t7C
3
In � =Iolf;
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_)
r 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
-- 4R-m"rty Owner
.�0-
Print or Type Naje1
o TYl 1 to KU
Mailing Address
r1� vA usst�_
City/statelzip
,,-�_4n - ,�O7 FS�l`l �-
Telephone Number
Date
(Adjacent Property Owner Information)
Signature
Pnnt or Type Name
.-15o l6K: -
Mailing Ad ress
atw %-), Inc, 2-�5
City/State2ip
Telephone Number
Date
(Revised 6/1WO12)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to i�t (I ; Alt T�QYYe-�- 's
property located at :Suy((kk—� -br(Name of Property Owner)
-�-,' (Address, Lot,Block, Road, etc.)
on Iy CY - ll�� in VC✓)Qe- t N.C.
(Waterbody) (City/Town and/or County)
T e aplicant has described to me, as shown below, the development proposed at the above
I dor_
I have no objection to this proposal.
✓i 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)
Maui !c1 ex r
�OGk
-cq73?-'
Ld
1} 11.4
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
wi§ih to -waive the setback, you must initial the appropriate blank below.)
)-�3 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner 1
Print or Type Nan2e
TY t 1'- Zd
Mailing Address
Svr�f v A 2z-5510
City/State2ip
15
Telephone Number
Date
( dj np t Prope U-1-
� I formation)
lure
�r C."01
Print or Type Name
Mailing AiddCess
_J�aern,
City/StatelZip
Telephone Number
Daie
(Revised 611812012)