Learnard, Clifford

-1CAMA / DREDGE & FILL
GENERAL PERMIT
CJNew Modification . 'Complete Reissue Partial Reissue
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
t,
No71639 A
Previous permit #
Date previous permit issued
Applicant Name , > Project Location: County
r
Address 'C.C% Street Address/ State Road/ Lot #(s)
City_ - State Q i ZIP
Phone # (- ) E-Mail Subdivision
Authorized Agent t - '� ? {z` ! City - -
Affected ❑ CW ❑ EW TA ❑ ES ❑ PTS Phone # ( )
AEC(s): ElOEA ❑ HHF ❑ IH UBA N/A Adj. Wtr. Body_ _
❑ PWS: -
ORW: yes / no PNA y / no Closest Maj. Wtr. Body
Type of Project/ Activity -- 'r"}" (ti
Pier (dock) length _
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
�`�
Basin, Channel ?� p J�
74
cubic yards (�
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
r �
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 Planningjurisdiction)] t l
Notes/ Special Conditions r `.0 T ?1 p.
{Agent or Applicant Printeam
c` ',
Signature leas0read"compliancestatement onback ofpermit
Application Fee(s) Check #
Rules attached.
B C D
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ZIP_
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River Basin �
gnat /man unkn
(Scale:
P See note on back regarding River Basin rules.
PermitOfficer's Printed Name
Signat e
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, 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 (252-946-648 1 ) or the
Wilmington Regional Office (910-796-7215) for more information on how to complywith 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 FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: (:/, 'Aed % Q 64'lr, c I,,; Z , 2_e=Zz'v,a1-J
Mailing Address: q66 (:!t-
/-)c w ,9c-ln A_) C
Phone Number: — � 31— / 3
Email Address: LL. h , 4'Fle ;S- C6Z) (::.�mc a s ILi f
I certify that I have authorized �E:2 i c ►'- c 63 ka- j_r C--v'1 ! ��
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Z x c- .,, ,,•ice -E , c)� / c {
6 C`�lt�:c� lids
at my property located at cG+�_ ��� " ,c`', c� C �-c-_ /3'cr: �� IkJ C-- . a L u
in C'.!� re-, County.
1 furthermore certify that I 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
L
Print or Type Name
Title
Date
t IECENED
This certification is valid through / I Z ° 3 2018
JUL 1
0CM-hflHD CITY

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Permission to Use Adjacent or Other Property
Initiating property owner seeking permission to utilize adjacent or other property:
Section Number: Lot Number: 3 3
Owners Name:
Ct(Z Pit c-,ex
_
Address: �`(� 6 01 #A �' `G r` d C A
E-mail: LU'V-%. l am s- Qc�� C-es"- c pA s•
Telephone Number:
Adjacent owner or other owner of lot to be utilized:
Section Number: Lot Number:
Owners Name: 9c b L r
Address: Cf C'Ck '
E-mail:
4.
Telephone Number:
As the initiating property owner, I understand that I am responsible for any damage to the lot identified above caused by any activity of
the contractor. I agree to repair any damage to the ground and ground cover by regrading and seeding, and, if waterfront property,
sodding any areas within 40 feet of the water. I have attached a copy of the "Description and Drawing of Proposed Work" form for the
adjacent or other property owner's information.
Initiating Property Owner:
Signature
Print Name
Date _3 Z.c7r Z .c > t '?
Adjacent or Other Property Owner:
I agree to allow my property, as identified above, to be used during the ourse of construction with the understanding that any damage
will be repaired as stated above.
Signature
Print Namebr� uG+�' c ✓� ' "t
Date L?
RECEIVED
jUL 13 2018
DCM-MHD CITY

Postal
CERTIFIED © RECEIPT
Domestic Mail Only
ru FO�IMVIIT9.
CC) I_Ifj Certified Mail Fee 21
5
$ r
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co Extra Services & Fees (check box, add teec�pete)
❑ Return Receipt (hardcopy) $
C 3 ❑ Return Receipt (electronic) $ 41 I - I Il I Postmark
[]Certified Mall Restricted Delivery $f 1 L Here
C3 []Adult Signature Required $ * —
1-3 ❑Adult Signature Restricted Delivery $
Postage EIS.71
M� Total Postage and e . 1
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O eei-and Apt. No., or PONai No.
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-70 -7
■ Complete items 1, 2, and 3.
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❑ Agent
A. �Rielci"ed
■ Print your name and address on the reverse
X ❑ Addressee
so that we can return the card to you.
C. Date of Relive
B. by (Printed Name) ry
■ Attach this card to the back of the Mail piece,
_ 4
'
or on the front if space permits.
D. Is delivery address different from item 1? ❑ Yes
1. Article Addressed to:
If YES, enter delivery address below: ❑ No
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3. Service Type ❑ Priority Mail ExpressO
I'III'I I'll I'I I II I IIII II I II I II III I I I I'III III
❑ Adult Signature ❑ Registered Mai(TM
❑ Adult Signature Restricted Delivery ❑Registered Mail Restricted
II
9590 9402 2651 6336 5515 06
❑ Certified Mail) Delivery
❑ Certified Mail Restricted Delivery ❑ Return Receipt for
Delivery Merchandise
❑ collect on
❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationT"
_ 2 Article Number (transfer from service label)
p insured Mail ❑ Signature Confirmation
Restricted Delivery
7017 1070 0000 8538 2164
` 1— red Mail Restricted Delivery
$500)
PS Form 3811, July 2015 PSN 753
Domestic Return Receipt

Adjacent Riparian Property Owner's Notification by
Certified Mail - Return Receipt Requested
Adjacent Riparian Property Owner:
Section Number: 7 Lot Number: 33
Name: P6 A_)1g t d { l-� e' r�i / d 1 L-��✓c ,
Address: 1- Y 1.4 0 q 1)1'. U,,, ; %' / b 3
Telephone Number: � _� �9`7
E-mail Address:
I hereby certify that I own the property adjacent to:
Section Number: 7 Lot Number: 2 3 u
Owners Name: el /, glef_clrz-d 1�,--
Address: '94) 6 D.,,a-1 Qr1GJ' ( �
Telephone Number: D — 3
E-mail Address:
The individual applying for this permit has described to me the scope of work as shown on the attached copy of the
"Description and Drawing of Proposed Work" form.
J I have no objections to the proposed work.
If you have objections to the work being proposed, please write the Division of Coastal Management, 400 Commerce Ave.,
Morehead City, NC 28557, or call 252-808-2808 within ten (10) days of receipt of this notice. No response is considered
the same as "no objection" if you have been notified by certified mail.
I understand that docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet (15'-0")
from my riparian line unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian Pr rty Owner:
Signature ���-, z t G- z Date:
Print Name.,' 1✓M-'D IAIU �
RECEIVED
JUL 13 2018
DCM-MHD CITY

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RECEIVED
juL 13 2018
DCM-MHD CITY