Rose, Leslie

A DREDGE & FILL `�' �'�' ' NO. 73499
CAM / A B C D
r. 'GENERAL PERMIT Previous permit #
New ❑Modification _Complete Reissue CPartial 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 EI Rules attached.
Project Location: County
Applicant Name _
Address ( I Street Address/ State Road/ Lot #(s)
City C^! F . k ! "' !y State ZIP.
Phone # (_)
Authorized Agent
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Affected ❑ OEA
AEC(s):
❑ PWS:
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E-Mail
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Subdivision
Phone #
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
River Basin
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Appl� Fee(s) Check #
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Permit Officer Printed Na -
Signature l( /
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Issuing ate 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/ 1-888ARCOAST
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)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/17

s � �
Date r 2 520 I
TO
CAMA Office
400 Commerce Ave
Morehead City, NC 28557
From:
Leslie R. & Margaret A. Rose
293 Bayview Drive (mailing address)
H11arkers Island, NC 28531
11)�c�r,. -12T-3.' 1? t'
Subject: Application for Clean -out permit
As a result of wash -in from Hurricane Florence, Sept. 13, 2018\
Riparian Landowner Forms
Enclosed are subject forms signed by adjacent landowners. Also enclosed is a drawing of
the areas of concerned — denoted by "x" along the perimeter of the haror and along the
east side of the canal (the west side of canal is marshland)
As you may notice, there are two addresses shown on the form. We own 287 and 293
Bayview Drive. The harbor area transects these two pieces of property — running east
and west and crossing the boundary line of those properties — thus the reason that the two
address numbers are indicated.
Should you have any questions, please call, e-mail (info shown on form) — or drop by the
property if necessary.
RECEIVED
VEB 2 7 N19
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
-41
or Street #, Street or
tt s,64
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 proposing. A des 'ption or drn'NA nu
x c tth 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. Contact information for DCM offices is
available at http://www nccoastaimanaaement.netlweblcn7lstaff-►isting or by calling 1-888-4RCOAST.
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, 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.
ppProperty Owner Informatiopa--�--�
act �. � , c� .
iz-
Signa e
Arm'
Print or Type N e
vi fir.
Mailing Address
CitylState/Zip
telephone Number/Email Address
?Zell �f y
Date
(Riparian Property Owner Information)
ii ature n
\rnn"nn'
Print or Type Name
Mailing Address
Klr-.,2$
City/State/Zip
,�-62, --27)(7�
Telephone Number/Email Address j:1FCF—NED
Date GFB 2
(Revised Aug: 2014�) ►1® CITY
0CM-

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
q-
'P"d DA •4- A3
or Street #, Streei or
City 8 County)
Mailing Address:
tL S64
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. h :tztm, or drawincl with dimensions must be provided with this kWer.
1 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. Contact information for DCM offices is
available at htto •//www nccoastalmanaaement.net/web/cm/staff-listing or by calling 1-888-4RCOAS T.
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, or lift must
be set back a minimum distance of 15from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
V*" I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Property Owner Informatio
Signa e
Print or Type NaRYe
MailingAddress
City/State/Zip
telephone Number/Email Address
Date
(Riparian Property Owner Information)
gnature
SA o DE L- , CQ t t>J
Print or Type Name
-1 a�7 x 3Z2
Mailing Address
aAJ4kCKs
City/State/Zip
Telephone Number/Email Address
02 Z 0- 20j q RECEIVED
Date
(Revised Aug14
F u) T 17 2019
DCM-MHD CITY

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RECEIVED
k,oFEB 2 7 2019
ON,
DCM-MHD CITY
44

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