Young, Patricia

ry
JCAMA / -1 DREDGE & FILL 4
GENERAL PERMIT "J)
APrevious permit # A B C D
jNew 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 15A NCAC
i=Rules attached.
Applicant Name Project Location: County_
Address Street Address/ State Road/ Lot #(s)
City- State ZIP
Phone # ( ) E-Mail __ Subdivisionµ
Authorized Agent — City z'"rrt` ZIP
❑ CW D EW PTA ❑ ES PTS Phone #
Affected ( ) River Basin
❑ OEA - HHF C IH ❑ UBA -1 N/A 1 _
AEC(s): Adj. Wtr. Body
❑ PWS: nat` man unkn
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body_ Iy t i'i
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
f
Boat ramp _
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no�,
Moratorium: n/a yes no f
Photos: yes no/�
Waiver Attached: yes no 14
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
1
i
Agent or Applicant Pnnped� Name
j
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
r.
(Scale: ,� )
See note on back regarding River Basin rules.
PermitOfficer s Printed Name ,
Y"
Signatuy6
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 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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 FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: nti t cI s} o c ev
Mailing address:
-277
Telephone Number: ` 1 i — ?�� s of
I certify that I have authorized����,
(agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of G,
at my property located at 3 a #/S V,`l e V-6)
This certification is valid through
(date).
(Property Owner Information)
�1
�es �Signature
Pint or Type Name
IItle, co. owner or trustee for property
Date
Telephone Number
ae-V1 V- e!C- c b - �t
Email Address

CERTIFIED M AIL'RETURN RECEI Eeun" D
DIVISION OF COASTAL MANAQEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIO
NNVAIVER FORM
Name of Property Owner
Address of Property: 3ag 5 J A ' U '
(Lot or Street #, Street or Road, City & unty) w �,
C
ao6b Q-P-Lo-m
Agent's Name #: _ rt t e- . Mailing Address: 00 nl�
..tS IPe1.
Agent's phone #5 a a Qi - 1 {a 1 `7 vLkS
t C- cl
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 wing_the development
they are proposing. dra
_I have no objections to this proposal. I have objections to this proposal.
IfYOu have objections to what is being proposed, you must notify the Division of Coasm managrement
(DClli� In wrltlng witltM 10 days of receipt Of this notice. Contact Information for DCM amce�s is
available atl)ttu_✓/www_,nccaastal,7�.�naaRmc�raLne,�ru�bJcnalata�.��r�1rn
No the sane as no ebl�Hnn ►f. .. 8— L__ orby calling t-888�4RCOAST.
WAIVER SEC71ON
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. Of
You wish to waive the setback, you i I the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
-Iperty Owner Information)
cc
g�q e
b.T e k�
$�®r�ma
a�Nnrin
Marling Address
a�60
cityJtat� —
19 - -7ga - Addra-7sg
Telephone lvumber/Emell ess
(Riparian Property Own f6 mation)
1
Signature
1,�. 4. G l�rJts ��. T�•s
'-I'm or Type Name
I �r- S-D Q
Melling Address
clry/stete/zl t`'�6-ron �� o �
Telephone Number/Email Address
6 12�
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property: , 3� 5 J
(Lot or Street #, Street or Road,'City & C unty)
3o616 CqLoa-,
Agent's Name #: C-O ► 1''�'A cl; avi -'n c . Mailing Address: LP J 0 3 ALP ,us
Agent's phone #: —_r�i 5 a - j 1% GY'a1,�t S L �1s G a ASS a "I
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.
' I 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
( .) g days of receipt of this notice. Contact information for DCM offices is
CM in wilting within 10
available at Faanaaement net/web/cm/staff iistinu orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been noted b 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)
�at e
Q.T' T)u
� t�.sbbJ C4,Io � Cd'vt��r v�Gf + cM ►� � .
'Print or Type Name
Mailing Address
City/State&
C)►
Telephone Number/Email Address
6- g _! �
Date
(Riparian Property O"Information)
w
Signature
Print'or Type Name
,�� �1 ,� ry `2-b
Mailing Address
City/State/Zip
Telephone Number/Email Address
Date
(Revised Aug. 2014)

PAT & STAN YOUNG
3245 JANIERO ROAD
ARAPAHOE, NC
DESCRIPTION
We propose to construct and install an approximate 15' +/- wide x 25' long
concrete boat ramp.

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