71112_Dennis & Pamela Madaris_20180911

�CAIVIA / __` DREDGE & FILL N2 71112 J� B C D
GENERAL PERMIT Previous permit#
4New 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 15A NCAC
X Rules attached.
Applicant Name ,r, ,,, 5 e PcArrm J 1a Ma L r � S
Address 151 EA( r Dr,uc
City C rc �, a . State ti t_ ZIP "A 4 q - ct
Phone # (113 ) VSI- Ac13 E-Mail
Authorized Agent S Kv, .4 8ro 4'1- /s
Affected ❑ CW A EW 2(PTA )1 ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / 6 PNA yes / 49
Project Location: County r ,' , A c K
Street Address/ State Road/ Lot #(s) I S 1 �u we >l+ D✓
Subdivision E' 1. 4 �
City a(cn Ov ZIP a, 14 939
Phone # ( ) River Basin -, le
Adj. Wtr. Body Cc.w 1 4o Do,. 41(3v,1 (nat_/Tunkn)
Closest Maj. Wtr. Body
Type of Project/ Activity +3,� W ►tic c r 2 01., u W .-.1l ar r � r 'r �
Fixes
Float
Fingi
Groi
u1k
Basil
Boat
Boat
Beac
Othi
Shor
SAV
Mor
Phoi
Wai,
(Scale: I - ' )
qi
len gth
number
7eadDRiprap length
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avg distance offshore
max distance offshore 1'
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A building permit may be required by: CU K
( Note Local Planning jurisdiction)
Notes/ Special Conditions
1A r im
Agent or icant Printed Name
Signature ** Please read compliance statement on back of permit
'#400 Do I�,ba.
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
PermitOfflcer'
Sign e
1aol9
Issuing Date Expiration Date

NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: h
Date:
Permit #: � I ) I a '�
Describe belo'#� 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
Dredge ❑ RIV Both ❑ Other ❑
I u (D
160
/ )a ! + I,u
Dredge ❑ Fill O� Both ❑ Other ❑
C, -
Dredge ❑ Fill ❑ Both ❑ Other-4L)
i (p
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.n_et revised: 02/03/10

A�
NCDENR
North Carolina Department of Environment.and Natura
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director
Date 4"-j-
Name of Property Owner Applying for Permit:
Mailing Address:
Resources
Dee Freeman, Secretary
I certify that I have authorized (agent) SmJ4 &A46e,5 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) & hZA6 ,
at (my property located at)
This certification is valid thru (date)
Property Owner Signature
0,111, jjj11r1',jjp N
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to Rvv Aqirf -5 s
(Name of Property Owner)
property located at
(ProjLyct Site: Address, Lot, Block, Road, etc.)
on in �GArrf,&Cf'c N.C.
(Waterbody) (City/Town and/or County) / ,
Agent's Name #: PIrl11 ,�k'l! •4 Mailing Address: lae SeaAYS(f
Agent's phone #: S r7"- 07 (7 Gage I, Ne 9.17?3
Ili
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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.
(Property Owner Information)
Print or Type Name
IdZ
Mailing Addre
City/State/Zip
703-F-5/-�9�.5
Telephone Number/Email Address
9 -Ulf ,
Date
(Ad' ce/nt Pro�wner Information)
!:-
Signature*
1,41w 1,11" iiwm
Print or Type Name
e j J�Q' 4( i/ J4fjK&-
Mailing Address
City/State/Zip
Telephone Number/Email Address
;�-� Ato�
Date*
f
*Valid for one calendar year after signature*
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to
AM A44r/6-5 I s
(Name of Property Owner)
property located at %:! / C �IC�Q,I.!/�. 46, lj�,���/.d1/ e
(PMject Site: Address"," Lot, Block, Road, etc.)
on , in 4rl-1 A445 , N.C.
(Waterbody)
Agent's Name #
Agent's phone #:
Parr P 5MA
5y1-07 ? 7
(City/Town and/or
County) Mailing Address: 5&gkt!5�,p
Ga,ge Ar a4A NC
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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.
(Pro erty Owner Information) (Adjacent Property O r Inf mation)
r
A&A&
Signature Si natu *
"PA,g&x Amdl s /
Print or Type Name Print or Type Name
A-0 &"Z
Mailing Addr
sa&d 2Z9 9
CitylStatelZipf
7e3- St3/- al4,6,6
Telephone Number/Email Address
Mailing Address
CityylSSt-atte� ;
Teleph e Number / Email Address
Date Date*
"Valid for one calendar year after signature*
Revised Jan. 2017

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