71242A_Thomas J. Oakes_20181031

L CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
[New ❑Modification ❑Complete Reissue ❑Partial Reissue
No 71242
Previous permit #
Date previous permit issued
B C D
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 N . UDO
Rules attached.
Applicant Name T. D G 4 > Project Location: County C %, + v .1- , k
Address III
City C u, n c o (.1L- State � ZIP 14 ci J,)�
Phone # (,z;;} ) 4 S3 - a S ii S E-Mail
Authorized Agent T )m l o .,n r
Affected ❑ Cw JEW [APTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / �rSo� PNA yes /
Street Address/ State Road/ Lot #(s) F4t,,,,,,,,,} Inc, 4.( J Q
t't+k,.n, Lon& v we-i+( 1,1,11 12 cl W,0 t►bto � # 114
Subdivision
City ('o�n�v�K ZIP a -1 5 a.3
Phone # ( ) River Basin P. s }�
Adj. Wtr. Body L Y_ So L-11 n an /unkn)
Closest Maj. Wtr. Body (1, • �,v lc So,.,, c4
Type of Project/ Activity A LA 1,:) r 1 d %Jv 1 ( e xi s +, iO, t ✓ f ��+ ^^
(Scale: z 3 D' )
Pier
Fixes
Flom
Fingi
Groi
Bulk
Basii
Boat
Boat
Beac
Otho
Shor
SAV
Mor
Phoi
Wan
phill
-
FLj"N�iiiiiiiiiii�iiii��ii■■�iiiiii
len
i length
■■■■■■■■■■�■■■■■r���■r�d��■�■wwu■w■■■MEN
umbe
number
■■■■■■■■■■ctvrn��■■■■■■�.®�■■r.�■■w■■■�■■
■■■ww■��■�.:.■w■■■Qo■�e�r►�u�■■■■■■
cubic yards
■■■i�i,7■■■■■■■w■■■■■■�.w�■■■■■■■1�1■
�■■■■
ramp
R!!■■■■■■■r�■■■■■■�es��w�e■■■■■[c�e�i�l■■■■■IOUs
adift
Bulldozing
■■■■■■C'�%
I■■■■■■■■■��■■■����ww■w■■■■■■■',dine
77
Length
not sure �,
■p►■■■1�1■L'd■■■■■■■■■■■■■■■■■ifi�1�■��i■■firtorium:
yes
yes no
t_w1 v­� A building permit may be required by: ! v,•• L (�
( Note Local Planning jurisdiction)
Notes/ Special Conditions
..L m, —T,(�,
Agent or Applicant Printed Name
l� <L �T n � 0 w 0 r1 k
Si re lease read compliance statement on back of permit *�
A),Cx) oc-) ►3ti )_
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
�oer�Gt�
Permit Officer's P ' me
Signature
101_ ►a
Issuing Date Expiration Date

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: () n�c 5 , Th
Date:
Permit #: —4- 1 �L y a'A
Describe belo'-�r the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Vi•
Dredge ❑ Fill ❑ Both ❑ Other
I ��
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1.888-4RCOAST :: www.nccoastaimanagement.net revised:02103/10

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ? J Z. c> 1 f
Name of Property Owner Applying for Permit:
s l.•
Mailing Address: /' l
de jni-
C10.4 lu 1 90 C
I certify that I have authorized (agent ! U-j to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) n a t L —(t V Aj / e r—
at (my property located at)
k- / N 1 .I —
This certification is valid thru (date)
!,�
Property Owner Signature

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: -3 °�+J C/4 k it i
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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 a+re/ proposing. 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.
J P P J P P
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. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. 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, 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.
(Property Owner Info r on)
z.
Signature
&2nAf _T 14-Zy
Print or Typ ame
ddress ll
AJloct, N�
TeleD on6t Number / Email Address
(Adjacent Property Owner Information)
1 r12�
Signature
Print or Type Name
Mailing Address
3 N J n '►yc
Ci4WState ip
(Z5,2� 5,53
i�ard
`Valid for one calendar year after signature*
Telephone Number / Email Address
Ji 1:�2-2-1201
Date
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: / h 0
Address of Property:
(Lot or
Agent's Name #:
Agent's phone #:
K/ f✓ 1' Z/� r,61161 ©(k-, AJ /� -,/ 1 2
#, Street or Road, City & County)
Mailing Address:
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 pro sing. 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
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. 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, 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15 setback requirement.
(Prope Owner Information)
Signature
A— !r I T, f),+
Print or Type N e
a_ g Address L
Alc
Cltoe ip
�elephone Afumberl Email Address
��h_�
Dat� / ,
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Signature * A--
ZL r b. 7�1_4 -e_
Print or Type Name
Mailing Address
J l ^!) (/
City/State/Zip
Telephone Number / Email Address
/ 0 //,�--A', / �,
Dare *
Revised Jan. 2017

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