Moore, Jerry

CAMA / DREDGE &FILL' (�?+� NO. 73407 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 ..
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name 9 ' Project Location: County_ t.Aty-) 1 t�
Address ` e Street Address/ State Road/ Lot #(s)
City 1 -' . StateZIP
Phone # (_ )—E-Mail
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Authorized Agent
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AEC(s): ElOEA ElHHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW- ves / no PNA Yes `/ no
Subdivision _
City
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Phone # (_ )
Adj. Wtr. Body
Closest Maj. Wtr. Body
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ZIP
River Basin
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Printed Name /
Sign %ure _� % f�
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/ 1-888ARCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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

01/18/2019 08:48 FAX [phone] NCOEPTENVIRONMENTNATRES
16 002/005
A(MNT %UTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property 01,vner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have at �thorized
194 h oI,
oel�u2�Aj, 4:
to act on my behalf, f )r the purpose of applying for and obtaining all CAMA permits
necessary for the folli ►wing proposed development:
at my property locate, i at
in County,
I furthermore certify , hat I am authorized to grant, and do in fact grant permission to
Division of Coastal M inagement staff, the Local Permit Officer and their agents to enter
on the aforementionE d lands in connection with evaluating information related to this
permit application.
dOerty r Informat'o
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Print or Tyx s Name
Tide
Date
RECEIVED
This certification is val d through I^,_ IJAN 18 2019
DCM-MHD CITY

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RECEIVED
JAN 18 2019
DCM-MHD CITY

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