Lazzerc, Michael

CAMA / DREDGE & FILL ti { ell ( No. 73471 A B C D
GENERAL PERMIT Previous permit #'
New Modification _ Complete Reissue - Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality -74, )�) � [�.-�and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC1. !f
❑fules attached.
Applicant Name f i�r l >'� ? c' Project Location: CountydJ
Address c n Street Address/ State Road/ Lot #(s)
City 1 J D State IV( ZIP i� � � Oe, I ",,
Phone # ( i j' � ��— .S1
Authorized Agent
❑ CW ElEW El PTA ES ElPTS
Affected AEC(s): E OEA ❑ HHF ElIH UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Subdivision
city 1_� / i�c�<� ZIP
-
Phone # ( ) River Basin r'
Adj. Wtr. Body v-. �' `'' ` t' man /unkn
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
I I
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) I
(Scale: 1A(, f
I
I I ;
'
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
j
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f
)
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I
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_
_
Boathouse/ Boatlift
Beach Bulldozing
Other
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-
—
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--
—
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-
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Shoreline Length
SAV: not sure yes no _._..._ _ L__.....__. —
Moratorium: n/a yes , no
Photos: yesno
Waiver Attached: yes no
J
A building permit may be required by: t'J 4 ",0^
( Note Local Planning jurisdiction)
Notes/ Special Conditions
:
i
- —=
See note on back regarding River Basin rules.
Agent or Applicant Printed Name Permit Office s inted Nam -
Signature ** Please read compliance statement on back of permit Signatur
Application Fee(s)Check # Issuing Date Expiratioh Date

f
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/ 1-888-4RCOAST 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: M I C f +tre L 4-1 Z Y?,+
Mailing Address: 1 - V V # ! i e4;2r=—'
S �I As
Phone Number:
Email Address: JCJ -2-2kt re�M-2 A -,A
I certify that I have authorized 45H
Agent / Contractor
to act on my behalf, for the purpose of applying for and taining all CAMA 1permits
necessary)the following proposed develo ment: L �LL��/� G
t�ce-� �� w 7/n ov
at my property loc ed at
l/
in wL� County.
1 furthermore certify that I 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:
l rr
A --
Signature
t,�k 4 r ( [A?7e4r'r1
Print or Type Name
�lUvILi`
Title
Date
This certification is valid through mil_! L_l_

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t "� 1 Cf-Ll - -7-7-+lre d 't' s
property located at
Zl -7 VJA-Tcn-l2. S Property Owner)
5Mihh)-�(302o Tu2AJ/r,) Address, Lot, 810 k Rpad, etc.)
on T511-5/h1 in SpWa gor;i�0 _. N C.
(Waterbody) (City/Town and/or County)
The applicant has described to me. as shown below, the development proposed at the above
locatio
qk
have no objection to this proposal
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(lndividuaf proposing development must fill in description below or attach a site drawing)
-1C1?eZuIL1D Do C-K I I Mw )-T411J 5f4'MC rvUT-Pr?1JJT-
r— `:5U L kt4E A-1> — WAIVER SECTION — I
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift. or groin
must be set back a minimum distance of 15' frorn my area of riparian access unless waived by
me. If o Zo
waive the setback, you must initial the appropriate blank below-*, )
ish to waive the 15' setback requirement
1 do not wish to waive the 15' setback requirement.
(Property Owner II ormation)
,1'rL�uut u�e
f�L CCiL L.A77ro%0R
Print or Type Name
lob pov<r2�Cr
Mailing Address
City/stale2ip
2 Ili- '1 -I0
Telephone Number/e+nail addross
Darr
'Valid for one calendar year after signature*
(Adjacent Property Owner Information)
.�rtn(rlrrrlH
G' t-) to leS AL, ttiY�
Print or Type Name
Ldiili
Mailing Addres s (� f � /t/ n c-
Z
City/Stalelrj
Ica 3~s94 —3464
Telephone Number/email address
G l�cxC'R 3�f Gb 121f<�Ll �a �
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to N I C�m�--�f�2•�-f�'�} s
property located at
2-� ��"1-�2 S C,GT pew Owner)
Stn%hw3` (3oJ?o TtjRApr7 Address, Lot, lo�k� Road ,etc.)
on t A-51 J . in _ W.,OQ e0; r
(Waterbody) (CityfTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
10 0
ceG.. I have no objection to this proposal
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
-11C I I
QE6"IL-V Do W I I W )TI41,J Sf-gE rooTPT21,J-F
r^ 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. of 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 O—wCer Information)
Ni ill rrr I "
_Mtr�w%eL LAz-terf�
Print or Type Name ,
telephone Numbed entail ad ess
910-5'fS-3f3�
Daw a l (.- I
'Valid for one calendar year after signature -
(Adjacent Property Owner Information)
xwra, a r Yr1 0
P ht or T pe Name
iWading Add ss
S .wt- As �a V` b
ClstrIzip
Telepnone Number /emad address
ja
(Revised Aug 2014)

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