Willis, Fanella

❑CAMA / -- DREDGE DREDGE & FILL N2 71604 A B C D
GENERAL PERMIT Previous permit#
ENew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental QuLgity
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ' �.. ZIP,
Phone # ( �`� "'''!Fail Subdivision
Authorized Agent zli i r' City __ ZIP
Affected ❑ CW ❑ EW A",- ,t] ES ❑ PTS Phone # ( ) River Basin
❑ OEA HHF ❑ 1� El USA El N/A
AEC(s): Adj. Wtr. Bod(nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / ho Closest MaI '. Wtr. Body
Type of Project/ Activity f^,
(Scale: '" )
Pier (dock) length
Fixed Platform(s) � —
Floating Platform )
Finger pier(s)
Groin length --
number ---'
Bulkhead/ Riprap length "
avg distance offshore-.. o
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift. - Q
Beach Bulldozing
Other li 1 )
Shoreline Length 1f"
SAV: not sure yes
Moratorium: n/a yes rn.
Photos: yes
Waiver Attached: yes no
� T
A building permit may be required by: - s ` . I C See note on back regarding River Basin rules. /
( Note Local Planning jurisdiction).
Notes/ Special Conditions'f
Agent or Applicant Printed Name
Signature * Please read compliance statement on back of permit
Permit Officer's Printed Name
Signature
- Issuing Date Expiration Date
Application Fee(s) Check # $ P

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 I) 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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date Z
Name of Property Owner Apply`ingffor Permit:
II
Mailing Address:
I certify that I have authorized (agent) /� G� (�^;-(" �'t S to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) 3 -- - e. .,iQ A 1 u,
This certification is valid thru (date) if J/
Property Owner Signature
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to L b' i u i s °s
(Name of Property Owner)
property located at <� �'�- '�u v►ew 1� lk
(Address, Lot, Block, Road, etc.)
on S = in /�� t� 7 � si , N.C.
I (Waterbo yci) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must flit In description below or attach a site drawing)
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.
X/ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
/
Sinature y
-r, V,cI�C- hlI sS
Print or Type Name
l fyf,,iew VlDA
Mailinna Address
Ci /Statam,
Telephone Number / email address
Date
Owner Information)
Sign re
ao n i r
Print or Type, Name
Z/7zl 7Lt�1 ,./ t d r
M A s
City/Statemp
)"4y qv - 7AI zccwb r t4j-e Grp CoLk
Telephone Number lemail address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

CONSTRUCTIONOUTER BANKS
MARINE
Tim Grimes. 252-240-2525 . Cell 252-241-6455
1501 First Avenue. Morehead City. NC
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HAND DELIVER
ADJACENT RIPARIAN PROPERTY -OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to IAJ 1 f f & 's
(Name�of Property Owner)
property located at., Kai4 U i c-t-i T Lrq
c 7 (Lot, Block, Road, etc.)
on --,in C�__ U-e ce , N.C_
(Waterbody) (Town and/or County)
Applicant's phone #: ift
/ Mailing Address: �-�4�/Vic+�., -U(�
Sa o� 6 ' c�o T T
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 pier/mooring pilings / boadift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSTD DEV' tOPIV 9NT:
(To be filled in by individual proposing development)
(Information for Property Owner
for Permit)
ear ,V tJ,
Mailing
City/State/Zip A)
I?.-�-�s
Telephone Number
plying ri n P erty Owner Information)
Signatyre
�:,, ail C Scoaain-
Print or ype ame
919-418-1943
Telephone Number
Signature 0 Date Date

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OUTER BANKS
MARINIE CSTRUCTION
Tim Grimes. 252-240 2525 . Cell 252-241-6455
1501 First Avenue. Morehead City . NC
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