Florence, Samuel

CAMA / ❑ DREDGE & FILL r /` No. 73984
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 ) / / ) <w / r li
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
r ❑.Rules attached.
Applicant Name _ Project Location: County_- t
Address C f "� J/ Street Address/ State Road/ Lot #(s)
City fr : State ZIP
Phone # (_ —_)_ _ E-Mail
Authorized Agent
Affected LD CW ❑ EW LI A ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ 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 offshor
max distance offshc
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure
Moratorium: n/a
Photos:
Waiver Attached:
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Subdivision
City �.—
ZIP
Phone # ( _) River Basin '
i e
Adj. Wtr. Body c'! -��- `� at man unkn
Closest Maj. Wtr. Body
(Scale:
L See note on back regarding River Basin rules.
PermitOfficer's Anted Name
Signature
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 I) 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)
(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

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Customer Contact Information
Date: j l _)h 9
Name: W k x N E -_)11� R (L L L t
Phone#: d S^,A aq1 (0G(09
Street Address of the Subject Property (or location):
DR aMCp'l�Lb ISLE, NC
Town and County: _
�M�Q�LD ISLt� CfZ4W_
E-mail (Optional):
VJ FcS A t 0_ 3Mai �` Co m
In Reference To (Please provide a brief description, such as "Need a permit for a dock. "):
0c�G PLRm 1`r FOR t`a ���QP�D Dk, L MC4_7qLb
I S L L::' . &f C MG_ Foo,VVV_1Ivy)
RECEIVED
MAR 19 2019
DCM-MHD CITY

O

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Samuel Newsome
Name of Property Owner Requesting Permit:
Ro. Box 1129
Mailing Address: King, NC 27021
Phone Number: 336-650-2657
Email Address: samnewsome75®gmaii.com
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Reconstruct deck on same footprint
that existed prioer to Hurricane Florence
at my property located at
Carteret
in
County.
1 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 withevaluating information related to this
pemtit application.
Property Owner Information:
Signature`
Dr. Samuel Newsome
Print or Type Name
Homeowner
Title
Date
RECEIVED
This certification is valid through
MAR 19 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �� r" wC I ,J c-wS o ir-, E s
(Name of Property Owner)
property located at g't a. t= k" E it rf L1I r- t-- w et-�. (�. �c f't /vL
(Address, Lot, Block, RoQad, et .)
on i�o= �..2 ++� �• N� in r+�.i2A (�% ,y C_ N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
t 1 1j� itidlLea
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ONR 2 610
111-MkAD C,�� 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adiace t Property Owner Information)
Signature Signature
�t ce P, v t,�
Print or Type Name Print or Type Al
3 i S- A m ve ri-►tire P l
Mailing Address Mailing Address , 7
City/State/Zip Qly/St//at i
a r6e Zit j'ir, t! 4]i%TC �i%G✓/%,
Telephone Number/email address Telephone Number/ e ail address
`l i(", C S C- 1 S
Date �— Date*
(Revised Aug. 2014)
'Valid for one calendar year after signature'

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