Williams, James

❑CAMA / ❑ DREDGE & FILL No 71330
� A
GENERAL PERMIT Previous permit#
[]New Modification ❑Complete Reissue El 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
0 Rules attached.
B C D
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City__ State ZIP
Phone # ( ) E-Mail Subdivision
Authorized Agent City ZIP
Affected -I CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): —1 OEA :, HHF IH ❑ UBA ❑ N/A Adj. Wtr. Body,.'-�.{_'_ ; ` (nat /man �unkn)
PWS:
Wtr. Body
ORW: yes / no PNA yes / no Closest Maj.
Type of Project/ Activity
Pier (dock) length N J,
Fixed Platform(s)
Floating Platform(s) "
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length r,
avg distance offshore
max distance offshore
Basin, channel
cubic yards '
f
Boat ramp 11
}} r' v r`
Boathouse/ Boatlift t
Beach B/ulldozin
Other 1 �q ` r•
Shoreline Length 1 C f -I
SAV: not sure yes no l
Moratorium: n/a yes
Photos: yes n
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or
Signature. _ "Please read
statement on back of permit 11
Application Fee(s) Check #
(Scale:
d
r r
n
See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signat
r
4�'G'
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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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 LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: IAL'1 445
Mailing Address: �� 1'41'$6W416/-y,)
Phone Number: 752 - 2/9— S2.&5
Email Address: ?6,ODU�c- /'?w9 �h14:L.t"'afi
I certify that I have authorized z9,e / w.�Ow
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1nfSTi A ap,9T D6�c A, -ID
at my property located at 507 /JL=L&-,
in � �1�t4 County.
l furthermore certify that 1 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:
Gv v
Signature
Print or Type Name
Title
Date
DECEIVED
This certification is valid through�l / 3� I ZO/� 15 20�a
---�— SUN
�CM.MHp CITY

DCM-MHD CITY

DJ C Ri AR1AN PRO WN}�R
I hereby certify that I own property adjacent to Property located at ,,,�* � li-/F,>Sf a {Name of F�apertY er)
on /Ui i/ J�_ r �,:i (address, Loti l3iock, R d, e_tc.}
in /ia1E. .I)
NUatterbod
Y) — — f rL , , N.C.
(CitylTTown and/or County)
The aPplicant has described to me, as shown below the development proposed at the above
iocation,..
t' 1 have no objection to this Proposal.
—�_ 1 have objections to this proposal.
DESCRIPTION ANDIOR I?RAWING OF PROPOS® UEVELOPIAENT
(Individual proposing development must fill in description below orattach a sits drawing)
l&w5 .SCr"G- mv-4c"VI"E7'!7' Az Z
,S
0,q-r �ctC >9� L r °S r�
liiIA1111=R SECTIQN
J understand that a Pier, dock, mooring pi}ings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area n of ripariaaccess unless waived by
me. (If you wish to waive the setback, you must irtkial the appropriate blank below.)
I do wish to waive the 15' setback requirement
r t"
I do not wish to waive the 15' setback requirement ~t. S r
(P PerY Owner Information)
(Adjace Property Owner Information)
SiE—
n1e�5 lci I,�r.r „e„
Pnmtor Name -
_7 s� f,Ae&x!r{
Maili A�W' ss
City/Stap?'Z/p C 2F1S�
57�2lS- 2 5
Telephone Number/ema# address
In 22 20/ $
DUte
Srgn e"
PrintOr D(Pe !dame4,0
_ j t�/Z'c, tJ 6
City/Stata/Lp Ci
Q' 'ti O
Telep a Number/email address
%f 'I 'p,/
Da ea �Cj
'Valid for one calendar year after signature' (Revlsed Aug. 2o14)
GC>t:
05/22/2018 6:41AM (GMT-05:00)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i
I hereby certify that I own property adjacent to �1 _r s
W64621L
property located at J�D? �c4SE(Name of Property Owner)
aup
,r (Address, Lo�' Bloc Road, etc.) ,�
on /SSG �i tlb2 in —2 x0� &VL: ( , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
Y. I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Re-14C- 47PtA417W&,AJr i D)L ?i20Posev lDE54Pry OF gooT
DOG AM0 1 P7
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.
erty Owner Information)
W W
Si n lure
es s
Print or Type Name
5-01 ME�(Sk i�i9K,#SoJJ... i3Ltl4)
Mailing Address
tier) &9,,( 1iL- 2$566
City/State/Zip
75-7 21 k 823.5
Telephone Nu ber/email address
h /23 7Zd/8
Date
*Valid for one calendar year after signature`
nt Property Owner Information)
�.nyi idtei iN
Te ephgwe vumber/email address Q
Date*
(Revised Au 014J�
�G