Coughlin, Daniel

v
CAMA / DREDGE & FILL
No 71618 q g C_, D
ENERAL PERMIT
4L'
Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous7pe�rJmit issued
,, Gam/
Environmental Quality J fJ 1
As authorized by the State of North Carolina, Department of
f
'
and the Coastal Resources Commissi n in an a of environm ntal concern pursuant to 15A NCAC / /
�, ules attached.
Applicant Name ,/� r r
Project Location: County
Address t.j
Street Address/ State Road/ Lo(s)
City r�'E` c t t Stater ✓" ZIP
Phone # Of` E-Mail
Subdivision
"�
ZIP 9 r-••r
Authorized Agent U
City
❑ CW &IrW -E TA ❑ ES ❑ PTS
Phone # ( ) River Basin
Affected ❑ El HHF IH ❑ USA N/A
AEC(s):
Adj. Wtr. Body � lYt' � t man unkn
❑ PWS:
Closest Maj. Wtr. Body t
ORW: yes / no PNA yes /Ln
Type of Project/ Activity �2 Xy ,-"j(;,- J "`s C'I & r
(Scale: ,.,V-J / )
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Groin length
number
Bulkhead/ RipAoffshore
avg dista
max distBasin, channe
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
i
SAV: not sure yes no
JIV
Moratorium: n/a yes no _
Photos: yes no -
Waiver Attached: yes no
i
A building permit may be required by: r , ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) f _
Notes/ Special Conditions A. ,
Agent or Applicant Printed Name PermitOffic r' P ntld ame IV
3 �
Si ure; Please read compliance statement on back of permit ** Signature
fApplication Feels)
4' Check# Issuing a E piration ate

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, certifythat 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting PermitL1— i J
Mailing Address:
�- tQ(-
Phone Number:
Email Address:�,�;(�;��;r�},(t,,,�,C�
I certify that I have authorized � �/v °
Agent / Contr for
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 2-\
in ('.i;((Zi F ._`"T 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.
roperty Owner Information:
n
i lure
Print or Type Name
Title
Date
This certification is valid through I

ADJACENT RIPARIAN PROPERTY OAR STATEMENT
n
1 hereby certify that I own property adjacent to �t._4l'f-A- Lu.-*,��Jkj 's
;� (Name of Property Owner)
property located at 'i _1 1 o .l -)(If- Ph- -
(Address, Wt Block, Road, etc.)
on in N.C.
(Waterbody) J (City oT�f wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
4 1 have no objection to this proposal_
DESCRIPTION ANDtOR DRAWING OF PROPOSED DEVELOPMENT
Ondrviduai proposing development must fill in description below or attach a site drawing
C 0 Uv k: cia- k S
��.ef;>
t1S j� 5;'
WAIVER SECTION
i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lilt, or groir
must be set back a minimum distance of 15 from my area of riparian access unless waived b)
me. (ff you wish to waive the setback, you must initial the appropriate blank befoul.)
1 do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback rec:uirement.
Signature
i�)&a.SiC 1t. H1-11,
Print or Type Name
"1 i I it_rzas ky- D
Mail' Address
�,1Ff�r">
fStatel2ip
Telephone. Arumberf email address (6illl
`'1117 1a
Dale
"Valid for one calendar year after signature"
(Adjacent Property Owner Information)
(Revised Aug. 2014)

Olt
ADJACENT RIPARIAN PRO_ ';QTV Qw'JcR STATEMENT
I hereby certify that I own property adjacent to
s
Property located at `-.` b (Name df Property weer) f
f �L�a� c
on (Address, Lot, k, Road, etc.) r
inz_ t— N.C.
(IVaterbody) (CttylTown and/or County)
The appliQent has described to me, as shown below. the development proposed at the above
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER UCTION
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.
160 not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Pr operty Owner Information)
___ _ _ __ _
rv7utrrre
C � ,
[ t •C.t�
�Nl t �'(y �E-tH1 the
l�rr���• _ ,-
Print or Type Name
d)VT i.l �' f ��
P ' t o vpe ame
Mailing Address
4-1 t+c t
ty/S.atetZ'
R s_�
Telephone Number, emailaddress YJKA11,
u[ [
P f 1
TelePhUyll
Nu ber/email address
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'Valid for one calendar year after signature` (Revised Aug, 2014)

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CA.RTi✓RCT COUNTY PLANNING AND DN111,1,01'MENT 1)I;PAR',t'A't
APPLICATION FOR BUILDING PERMIT
Courthouse Squam + Beaufort, N.C. 28516-1898 iAPR J! t cUi11
Main Office (252) 728-85,15 + Westorn Office [phone]
PARCEL, ID /!:____ 'j?,SU �l�011A IAGOd DAT[i•
PROPERTY OWNER NAME: 0a11
PIiONE11: �1 L �'7� r/�'6...�.__ _ _ E-Mail_ — ©cis --
AGF,N1'NAME: ,P110NliN:aSd-t�E-Mail- ;SCE
LOCATION OF PROPERTY: ail Lq ti/g/p,4 __1r3� n� yt _
DESCRIPTION OF WORK: _t , p G� C�d re
BXISTING STRUCTURES:k
CANIA PERMIT YRS / NO 11
HEATED Sr:
TYPE Of CONSTRUCTION: No. OF STORIES:
-- LOT SIZE: 2, � ✓2;06
UNf1FAT3D SF: 1605
- _ OCCUPANCY TYPG: ,f r
COST/VALUE:$„ z . MANUFACTURED IJOMK('I..ONIs: ) &XPOSURfs 1): Y>;S/NO
NEIV SEPTiC:1'E?S / t(, • NEw WELL: YI?S /o PUBLIC WATER AVAILABLE: YC4 /<!g HOr BED / BA'f1IR00MS /'
GAS: YUS / W IF YES, HOW MANY APPLIANCES: _
OPGRA'fiONS )'GRMI'1' 11 / AUTI-1. TO CONSTRUCTM
CONDITION1iD CRAIVLSPACG: YES /,�19?SQUARB FOOTAGG OF AREA' OBE UNCLOSED
COMMENTS:
OWNER / AGENT SIGNATURL: !!�
FO.IZ"6PTIC1AL USE ONLY
CASE / PERNIVI' /!ol
i COMM NO, PAN. NO. SUFFIX DATE OF FIRM FIRM ZONE BASE FLOOD ELEV. ELL•V. CERT. BASE: FL400
i
i �12 r� ,' REQ. ELEV. REQ.'
y /tJ / C �/ 9
t SO Jwv)tiR REQUIRED 'E? U PUBLIC WATER REQUIRED: YE, DRC S NO
i JURISDICTION:
I - ZONING:
2—MAX BLDG HT';
SI.1']3ACKS:Plt]NCPAT___T... 50 REAR _ /.Q SIDE _—SIDE` ON CORNER
ACCESSORY ST1t]JC1'U1tL': ___,:JQ.__.__fRONT�REARr� SIDE,
TYPLOF SUSINGSS: —NO.OF EtEQ. PARKING SPACES:
SIGN REQUIRENIEN'fS: ,�^
COMMENTS:- {'i/�l� A VG�J C� � a ! CcS _ - -
� wee
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L�
Hogue Cedar Point Comity Indfau Bcactt Ycicltor
The Applicant has certified that the information shown on tha application, plans And specifications is correct end inte to his/her knowledge. All
work porformed shall comply with the North Carolina State Building Code, Flood Damage Prevention Ordinanco of Carteret County And All
other regulations, rules and ordinances ns Applicable. tvtisinformation, lack of information, or statements made in error could result in
-revocation of all permits And suhject the owner/agent to litigation in the process.
CalleDi � P�-{ `��a5�yss

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