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CAMA / DREDGE & FILL` -'N
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
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name _ _ _ _ Project Location: County
Address
Street Address/ State Road/ Lot #(s)
City _ _ _ State ZIP
Phone # ( )
E-Mail
Authorized Agent
❑ CW
ElEW ❑ PTA
Affected
AEC(s): ❑ OEA
ElHHF ElIH
❑ PWS:
ORW: yes / no
PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Agent or Appli t L rinted Namef >�
' Z 'Q
Signature` lease re d compliance statement on back of permit-
,r`
Application Fee(s) Check#
Subdivision
City
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body__
ZIP
River Basin
E - --•.- t'1''"'77
fnat /man /unkn
PermitOfficer s Printed Name
r �_
SignatW/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, 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 (252-946-648 I) 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: 252-247-3330 Fax: 252-948-0478
(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: 252-264-3723
(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: 910-395-3964
(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
A'*A
MCDE-HR
Nib Carolina Department of Environment and Natural Resour,Pat MCCMfy __
Division of Coastal Management
Braxton C Da
Gov r Qirector vis DOOM R. tf' Val
Date 4j*�<
applicant dame__ �----"
Address
CAMA Permits necessary to install or construct (activity)
JAW -
at (location)
on is valid thru (date) 1 «Z
Col
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Traci M Tate
Address of Property- 322 Main Street Vandemere, North Carolina
(Lot or Street #, StWet or Road, City & County) 7
Agent's Name #: MailingAddress:
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are posing. A description or drawing with dimensions must be provided with this letter.
1 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at httn•//www.nccoastalmanogement.net/web/cm/staff-listing or by calling 1-888-4RCOAST.
,,,.. No response is considered the same as no objection if You have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
Owner Inforration) (Riparian Property Owner Information)
� Wei
Si lalur•e Sign alrn�e
Traci M. Tate Max Dare
Print or Fy-pe Name
Mailing Address
14313 Derby Ridge Ct.
City/State/Zip
Midlothian, Virginia 23113
Telephone Number/ Email Address
919-741-9328
tdusenbury@halconcompanies.com
Date
Print or Type Name
Mailing Address
360Main street
City/St a te/Zip
Vanslemere, North Carolina
Telephone Number/Email Address
601-504-3744
max@durasip.com
Date
(Revised Aug. 2014)
a
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: � � M �11 �1 3Z Z t
(Lot or Street #, Street or Road, City & County)
Agent's Name #: �f L i Mailing Address:
_ Q
Agent's phone #: ( icy �� 1 /„l�cl �: U,� t /?A�
9
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastaimanagement.netlweb/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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)
,�� '011�x
Signature
Print or Type Name
JKi arian Property Owner Information)
Signature
Ca M a i e.. f, rItA 2% .k4(�L wl
Print or Type Name
Mailing Address Mailing Address
City/State/Zip fdUSeo City/State/Zip
) a
Teleph ne Number/Enhail Address -Telephone Number/Email Address
-1—(,o ~I� `7/� 113
Date Date
61
(Revised Aug. 2014)