Wilson Brothers Holdings LLC

❑CAMA / ❑ DREDGE & FILL No 71315 A B C D
GENERAL PERMIT Previous permit#
GNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality (❑j r
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7� `'" /
? Rules attached.
�, 'Project Location: County Applicant Name �� "' Pro 1
Address (`�(t'} } =k' Street Address/ State Road/ Lot #(s)
City
� � ' ' � t� State i V� ZIP
Phone # ( ",� -�`
,'� E-Mail
Authorized Agent
❑ CW
ElEW *A
❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ 1H
ElUBA ElN/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length i' `_, 1
.a
Fixed Platform(s) S
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore '
max distance offshore
Basin, channel
cubic yards
Boat ramp
� r }
Boathouse/ Boatlift
Beach Bulldozing
Other
Subdivision
- 3
�- ff
City"" t.( t s/, c:f t ZIP
J �- �y
Phone # (I) -I (� �C�i* �T ]River Basin
i
i l-
Adj tr. �o�y lI 7 Zvi ! `i ' V� (nat /man /unkn)
Closest Maj. Wtr. Body
iI HN 1_ / x` 1
A1171
E
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no t
_.......-- - _------ . .-.----
Photos: yes no
Waiver Attached: yes no
A building permit maybe required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
AU
Agent or *plicant Printed N3rhe
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
i
(Scale: / )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Nam
Signature
c ;
Issuing bate 1 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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

'A
P'ropedy looa led at Y\ KT-"-
on (Address, Lot Block, Road, etc.}
in N�C
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
iocatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(lnd1v!dq#1,p,r*p,osing development must fill in Owqd _"-below or attop
A
R
/Z'� I
AIVER SECTION
eln
up
-46
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 not wish to waive the 15' setback requirement.
(i'rope Owner Information)
(AdjaceEt Pr n r a
print or 1" po Name
Print or Brantley I. Burnett
� 5 � V,
M, riling Aid res
Mailing A( P 0 Box 1359
'/7 mks /k 0— K)od, WY1
Roxboro N C 27573
Telephone Numbor omall address
Telephoix,
919 210 0024
Ism;
f(Rev
Aujj` 4)
'Valid for one calendar year after signature*

i
l hereby mflfy that l own
{game of Property -Own
e
are a A nC� 4,A'dctr , L Slack, ad, -stO N.c. In
(IAtatarbt►dy) (11,1ttlow srWO. County)
1 The appligant has &scribed to ma, as shown Wow, the nr ptnantpro
poW at the ,above
l€►Catlq .
t have-oo.OWon to tills proposal.
-400
t [11At�t t+Alhtt t�f. ski
Mk
ti.
UINi1MMYM1 .. � `
46
(Revised Aug. 2014)
*Valid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OW14MSLATEMEIYT
I hereby certify that I own property adjacent to � o . w i e s o �t 1;2,t-LC, $
(Name of Property r)
prey located/fat
on 2 / � nG� (.Address, Lot, Stock, Road, etc.)
{Waterbody} in ��� �GA _. N� C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location..
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 b*low, , ##MAg%t: drawing)
t?
G
i
WAIVER SECTIQN
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 y area of riparian access unless waived by
me. (If you wish to waive the setback, you must Initial the appropriate blank below.)
1 do wish to wavvf, the 15' setback requirement,
I do not wish to waive the 15' setback requirement,
(Ptope Owner Information) (Adjace t P,
rcu Pwn n o at
*Ignsi
Print or �rX�e ntarrro t� Part or T Brantley I. Burnett
M iiingA, ress iWailingat P 0 Box 1359
i k CityiStet� Roxboro N C 27573
Telephone Numbofilernall address �� Telephone
/ 919 210 0024
bate'-, �. ��itr• �--/
`Vend forone calendar year after signature' (Rev4d Auii4)

l hereby cot* that t own property adjacent to Lc-CG .s
JNSMe of PrOPO* Ibj.j terf4)S
pr« po 100ate d at 111 _ �; r-,V
D /� (AdM", Lot. .. ' +ytc.
an �`I 2 /�� nc.� , In cis . N.C.(Watarb d t} (C#fiY/Town addior County)
The aPplWant has desatbad to me. as shown bebw, the development pmpawd at the above
tor�tivn.
. f have::po.gb Cdon to this proposal,
:.
*Valid for one calendar year after signature` (Revised Attu 2fI f 4)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date d/ 1!
Name of Property
%Owner Applying for Perm/it::
Mailing Address:
I certify that I have authorized (agent) Imn ;—f1 iVlpfi to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Gr
at (my property located at) I N ' `� ffee� 4,n Ace 96--cl, nJG d-& S/a .
This certification is valid thru (date)
r
' Property Owner Signature / Date