Babin, Brian

CAMA / ❑ DREDGE & FILL ( NO, 73426
.i I � A B C D
GENERAL PERMIT �Previous permit #
1New 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
❑ Rules attached.
Applicant Name, 1 '�� !� , Project Location: County jf
Address
City_,
State ZIP
Phone #�
11 r
E-Mail
Authorized Agent
Affected �`CW
PTA [IES ElPTS
❑ OEA ❑ Py 1F
AEC(s):
❑ ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA
yes / no
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
Boat ramp
Boathouse/ Boatlift
Street Address/ State Road/ Lo #(s) klf Wirt
-- —
Subdivision
City i f.ZIP
Phone # ( _ r _) f ^ /kiver Basin
Adj. Wtr. Body r`;` (nat�unkn)
Closest Maj. Wtr. Body I /A �
Shoreline LengthI XYI
SAV: not sure yes no
)— -
Moratorium: n/a yes no I
Photos: yes no i
Waiver Attached: yes no
A building permit may be required by: j
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) r Check #
(Scale:
❑ See note on back regarding River Basin rules.
Permit Officer's Printed N e
Signature
- 2 / & (�
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 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] 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)
(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

.It
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: " l �� ' D �-7 r (6,7
Email Address: ' �''1 E'`g J- C- o-c �� t L" cco 0A
I certify that I have authorized ��l�n���Sse-gas
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: c r\
at my property located at
in Gtf--6ref ' County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Title
/a / /s/ /
Date
RECEIVEr,
This certification is valid through
0 2oig
7 C17`y

ame of Pnop Owner)
property located at < <Pt (Ls)z' Utizr
(Address, Lot, Block, Road, etc.L
on N.C.
(Waterbody) (CityfTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location,
I I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
L/ndty diral`proposing deyelopmenf mUsf fill in desc n bq or attach a s drawing)
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, brealewater, 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.)
A I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement_
(Property Owner Information) (Adjaent Property ner Information)
,-Signature
Print or Type Name AS
Mailing Address
City/StateM A
�'4 � 'f_l(?5-76 �18Q&/33ity� 1)�T11q4(_
Telephone Number/email address 'Cus,
Date
*Valid for one calendar year after signature*
J DIAP H, JNCk' EJ
Print or Type Name
Mailing Address 1b
C� State/Zip
Telephone Number email address JN,/V 3 0 ?019
Date* ' 1
(Revised Aug_ 2014)

I L

charles wray
Jan 11, 2019 at 4:41:44 PM
brb�ull I lk&JI I
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WAIVIOS5an "— sez
q -tef' boatv
j understand that a pier, dock. mooring PWN-3s, bOOt tamp. t.lff�ak'Na n Unless WaAled tll
a ta ble
must be set back a minimum distance Of 15! fr'DmirkitiM area
(�t vipa'na b
me. (If you wish to waive the setbacK YOU must at Abe -appTQPTiat--
- ' We - setback requifemcnt-
C, \A) I do wish to W-a- the 15
waive the setback requi�r!��rner'�-- --------
I do not wish to
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