Shearer, John

OCAMA / ❑ DREDGE & FILL N1 2 71400 A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued j
As authorized by the State of North Carolina, Department of Environmental Quality i ?-, - f
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC J Y"�
0 Rules attached.
Applicant Name_
Address
City
Phone # ( )_
Authorized Agent
Affected ❑ CW
AEC(s): [I OEA
❑ PWS:
State ZIP
E-Mail
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
ORW: yes / no PNA yes / no
Type of Project/ Activity
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
cubic yards / r1 �-
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other F
Shoreline Length'
SAV: not sure yes no
Project Location: County
Street Address/ State Road/ Lot #(s) ¢ t.
Subdivision > t f'. [ ,
CityZIP
Phone # O River Basin
`.�
Adj. Wtr. Body 5 t�'3 " ' 't _'{(natiaA /unkn)
Closest Maj. Wtr. Body"`—�
(Scale: _ )
Moratorium: n/a yes 1 no—i—
�t
Photos: yes no
Waiver Attached: yes no I I I I
See note on back regarding River Basin rules.
A building permit may be required by:�J E �%
( Note Local Planning jurisdiction)
Notes/ Special Conditions '
- / r
Agent or Applicant Printed Name
Signature ** Please r "d compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Printed Na
: 1V(
SignatYate
/
Issuing E iration 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 howto 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/ 1-8884RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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:
Mailing Address: Ids �e�^fin ��'»` e
2- I�
Phone Number: 2, - Z4 Cy/
Email Address: ��hn 6r`S�7G�� /'�' �e• �''r
I certify that I have authorized C+�'► l� �Q k�
Agent /Contractor
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 o, -4evl e(
in (,9rAVell County.
1 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.
Property Owner Information:
Sig ture
Print or Type Name
D Yvr),e 45
Title
—Yl 2 l/ 7
Date
This certification is valid through YI I / 2*19 RECEIVED
JUL 13 2018
DCM-MHD CITY

Appendix A
Adjacent Riparian Property Owners Statement
(for a bulkhead, dock/mooring pilings)
I hereby certify that I own property adjacent to ,fin` %�,��,,�c%1,t�,,,�`4- �Al 46
(Name of property owner)
property located at /Og s- �/
(Lot, Block, Road, etc.)
on �p4i r-- , in
NC
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a dock/mooring
pilings must be set back a minimum distance of fifteen feet (15') from my area of riparian
access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
Description and drawing of proposed development:
(To be filled in by individual proposing development)
i
s�� Q ��t.-��-1� p2SGrr�»-j GL►^4� .�f� v✓i!� ���'��'��
J
Signature G,% /
Print name
Address
r
Date
63� -CDC
Telephone number
RECENED
m 13 Zola
DCM_MHD CITY

Adjacent Riparian Property Owner's Notification
by Certified Mail - Return Receipt Requested
Adjacent Riparian Property Owner:
Section Number: 5 Lot Number: l 497
Name: R- rn h) co
Address:
Telephone Number:
E-mail Address:
667 7-Y ej6
I hereby certify that I own the property adjacent to:
Section Number: Lot Number: i b �C
Owners Name: , Lo A E) )f�J Ct��Lr y/`a rr;e
Address:
Telephone Number: T� I ' 6 % Z"a 4y6
E-mail Address: jAAri e-,Ptn
U
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.
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
Signature
Print Nam
RECEIVED
JUL 13 2018
DCM-MHD CITY

a c, c 1ll 1 1 Ali
1
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RECEIVED
3UL 13 2018
DCM-MHD CITY

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