63944_Richard and Sandy Gerard_20190312

XCAMA / DREDGE & FILL ' No. 72977 -,CA
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GENERAL -PERMIT'S - �4 Previous -permit C D
❑New _ ❑Modification . ❑Com lete Reissue = ❑Partial Reissue Date previous,'permit
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" "As authorized by the State of North Carolina;. Department -of Environmental Quality
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and the Coastal Resources Commission in an area of environmental co tern pursuant to 65A NCAC
//� Rul 's attached.
p. Applicant Name GI/f�c'� % �?di'!'l�l 4��'% Project Location: County
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Address r D r1l cA /1G .. Street Address/ State Road/ of (s) 0%- /
pfj State �I�C,ZIP ._
Phone # (2�3 "�?OU'. E-Mail Subdivision 1 -
Authorized Agent',' �Jr��� 'G - city /, ZIP - i7"'/D
Affected ❑ CW 'E . .,LS.PTA ES PTS Phone # ( ) �— River Basin / o%
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body /v9 G ���� nat: an unkn
❑ PWS:
Closest Maj. Wtr. Body
F ORW: yes / [�� PNA yes / o \
Type of Project/ Activity
Pier
Fixed
Float
Finge
Groir
Bulkt
Basin
Boat
Boatl
Bead
Othe
Shore
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A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
rl�
Fee(s)
compliance
t on back of permit
! Check #
r��
XSee note on back regarding River Basin'rules. -
1
S�rzl_ �4�- -
PermitOffcdr' P inted a e
�
Signature
Issuing Date E piration Date

Authorized Agent Consent Agreement
r.,em rl herb authorize Tobin Jay Tetterton of
Y Y
(Property Owners )
TJ's Marine Construction, LLC to act on my behalf in obtaining CAMA permits for
the location listed below.
PROPERTY ADDRESS:
i
NO W-16
.PROPERTY OWNER'S SIGNATURE:
AUTHORIZED AGENT SIGNATURE:
TOBIN TETTERTON
DATE: 3 .-V - 20�7
W/Authorized Agent Consent Agree.

I hereby certify that I own property adjacent to
% 4 n s
P P / 07 f� " t �" ( I-dll -pew Owner)
roe located at
(Address, of I pk, Road, etc. 4on i1 in / aL`Qt1t- , N.C.
(VUaterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca 'o .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must FII in des
cription^below or attach a site drawing)
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. (If y u wish to waive the setback, you must initia) the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property O ner formation)
(40
Al.ilLt1/YP - .
►1ll��i � � o'
Telephone Number/email address
Date -
*Valid for one calendar year after signature*
Uty/State2Mp
Tele hone Number/email address
-Q ,i q
Date*
(Revised Aug. 2014)

r
I hereby certify that I own property adjacent toi,G�Q/' ��i ���d% ,
s
(Name of Pr perty Owner)
prope located at
(Address, of IVk, Ro d, etc.on i1 ,in IG� t , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
✓ 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or aftach a site drawing)
eo
Q#roX d 75" �t/)
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. (if you wish to waive the setback, you must, initial the appropriate blank below.)
spa
✓ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro erty Ow er Info ation) (Adjacent Property Owner Information)
City/ Wet_94/
Tpep one Number/email address
r"l -,.J L _'-) i r 4
Date
*Valid for one calendar year after signature*
MS,ature*
Pri y0 Type a
pa�G
e /Sam 'low
M01,11ing A dre s
City/State/Zlp
t-
Telephone Number/email address
3—� — kq
Date*
(Revised Aug. 2014)

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: p r LA4 J'� l/!/7� ���I 6e f G► /��
Date; a, 111
ral-I 906 /
General Permit #:��-1�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL-Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
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Dredge ❑ FilljX. Both ❑ Other ❑
l�J� iGt%h�
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
- w s, s: - -d6 1 :c guyy*nx.r w i r „ a Y.r, t revised- 2; 3A