Ennett, William

'� No 73395
.'CAMA / DREDGE & FILL 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 (.� �a y
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ///� Rul attached. "
Applicant Name
t',✓ r ( 1 [ +�`� ✓1 �" Project Location: County - 4, TrT
Address
City r', C le ' ' r State A)('ZIP_
Phone # (_ ) 'W r-' E-Mail
Authorized Agent
Affected [ICW EW efTA [I ES ElPTS
❑ OEA HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS: _
Agent or Applicant Printed Name
Signatur jlk* ease read compliance statement on back of permi
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s
X)
Subdivision
City t _ f'Cr `�' �^ ZIP
Phone # O Ri r Basin
Adj. Wtr. Body l�"�� n�t man unkn
7
Permit Officer's Pri ted Name
Signatu
Issui g Date xpiration 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 -
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
(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1, )1 LLI AhA f_ a ►. l F TT
Mailing Address: 1_2[y-j
Phone Number: 25-Z 343
Email Address: -btl-
I certify that I have authorized tANU \n 'C- .
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: it
at my property located at 1'2C>4
in 0.RCC-Qr County.
I furthermore certify that l 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:
A-
-'26 � : `
Signature
Print or Type Name
Title
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � t , ' �- � aF -N:s s
(Name of Property Owner
property located at ' L{ )4- F�l a`�.C- �, �. �t ! C **rX ]r . �). . r
on
(Waterbody)
(Address, Lot, Block, Road, etc.)
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc rYl
I have no objection to this proposal.
_ -- I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must till in description 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 you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
ity/Statjl ip
Zr Z� xl 3 Kt i i-ill'-n
7`61006nq Number/email address
Date
'Valid for one calendar year after signature'
Property Owner Information)
/11
Telephone Number/emai address
Z �v
Date"
(Revised Aug. 2014)

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
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_description or drawing, with dimensions must be provided with 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 athttp://vr vv,,.nccoastaimanaaement neyweb/cm/staff listing 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.
(Property Owner Information)
Signature
Pnnt or Type Name
Marling Address
City/State/Zip
(Riparian Property Owner Information)
Apr
Signature
Pnnt or Type Name �—
Mailing Address
City/State/Zip
Telephone Number/Email Address Telephone Number/Email Address
Date —
—
Date
(Revised Aug. 2014)
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BOGUS SOUND
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1199 NNE F00f WV *VOa:
N MORf, NC 28510 PLAN
252-665-4378
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