Kaplan, Peter & Fran

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❑CAMA / ❑ DREDGE & FILL No 71942 A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality f
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules 7ced,
Applicant Name �� ;, Project Location: County
Address
City State i ZIP
Phone # (' ) ! - t-Mail
Authorized Agent - --- ---
Affected � CW EW A ❑ ES ❑ PTS
AEC S : ElOEA —' HHF IH ❑ UBA El N/A
() ❑ PWS:
Street Address/ State Road/ Lot #(s)
i1t�-' I
i'-4 - ,
Subdivision
City �. �' - ZIP
Phone # fiver Basin r
Adj. Wtr. Body (nat /man /unkn)
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Agent or Applicant Printed Name
r
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
-- =—
PermitOfficer's Panted Name
Signature
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to U Zf ��A 's
(Name of Property Owner)
pro
on
(Waterbody) 13 �. u C S� A-V
(City/Town and/or County) %J
The applicant has described to me, as shown below, the development proposed at the above
locatio
1 I have no objection to this proposal.
i
1 I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
RECEIVE[
SEP 01 2017
DCM- MHD CITY
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.
(Property Owner Information) (Adjacent Property Owner Information)
Signature Sigrpbture
Print or Type Name Print or Type Name
I / 5-- /77 19R Y, � / 4y i 114 C'
Ma� ng Aess Mailing Address
City«tate/ZiD City/StatelZip
Z> L' y(-,---7 7'3- llnob
Telephone Number Telepho a Number
S � 1-7
Date Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to IfC le7O�'4`%/ L 's
INanie of Property Ownerl
prc
on
—4>V V,KI-- � 0 "4,b
lrcn --;, 7b
The applicant has described to me, as shown below, the development proposed at the above
location./
1'./_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
RECEIVED
SEP 01 2017
WAIVER SECTION ®CM- MHD CITY
1 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.)
iyc I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro nor Information) (Adjacent Property Owner Information)
Si ature t nature
Print or Type Name Print or Type Name
41
113 All a
Mai ing Ad ess Mailing Address
A/G u;2 A n zz
City/Statelzip CdylStatelZip
"7- qd �- ©%� Z 3 3 � 931 ti` J- 77
Telephone Number Telephone Number
Date Date
(Revised 611 &2012)

ECEIVE
� SEP p 1 2017
ACM- MHD Cl
1 °

Ro,
RECEIVED
SEP 14 2017
DC MAID CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to QA't / -i/ GX s
(Name of Property Owner)
property located at % /; /�% % L,� Z- L /7-111 -mod lee l� 2 4� / J
(Address, Lot, Block, Road, etc.)
on �`►1 r /rv� L1/,,/ �— x in Nv ✓�'yl : C �f � 1 , N.C.
IF (V1laterbody) �o l�� S � j, , 0 (City/Town and/or County) Z S577D
The applicant has described to me, as shown below, the development proposed at the above
location./
_i�' I have no objection to this proposal.
I have objections to this proposal.
- • •- �-. • -•-• ::is •-r
S y
k L
SEP 14 Z017
®CIS- MHD CITY
5.
rw4ew_Mo AHD CITY
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)
Signature
Print or Type Name
u,
Mailing Address
City/State/Zip
252-
Telephone N mber/email address
1"17
Date
(Adjacent Property Owner Information)
Signat re
Pnnt or 1 ype Name
S 4,-]
Mailing Address
Cit / tatelZ'
3367R 7 7 boo
Telephone Number/email address
Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*

1, v' 1.7 t,, �, ,V t� J W .e A`, G, Pz
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at_
(Address, Lot, Block, Road, etc.)
w T=' .__, N.C.
(Waterbody) v G'Ll el- S1,0 ti)S (CitytTown and/or County) a �?'s7v
The rpplicant 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 x
��
RECElVieo
SEP 14 2017
®1WH® CI T
Y
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. Q 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.
(Propefty Owner Information)
(Adjacent Property Owner Information)
IV
We
4in t(li t u / .Jtt
A 7 fe
Print or Type Name
Print or Type Name
t�1ar .�1 Achi nss
Mailing Address
CitylStatelZip
C:it�te/Zip � 3 � 7?
Telephone Number/email address
Telephon N/umber/email address
(Revised Aug. 2014)
"Valid for one calendar year after signature"

Styron, Heather M.
From: peter kaplan <[e-mail]>
Sent: Wednesday, May 09, 2018 4:37 PM
To: Styron, Heather M.
Cc: [e-mail]
Subject: [External] agent authorization for cama permit
Hi Heather,
Attached is the form I picked up and filled it out so that if and when Eric Pake
starts my project he can pick up the permits at your office. I will be out of town
for a while but if you need to reach me you can call my cell phone or email
me. If I return before Pake starts I will come by and pick up the permits.
Thanks,
Peter Kaplan
1