Gardner, Jessica

CAMA / DREDGE & FILL'
1 U `�" NO. 73948 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 r'' u C/
and the Coastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC
J
❑ Rules attached.
Applicant Name ('�i ` `
Project Location: County
Address J ? `~
Street Address/ State Road/ Lot #(s)
City -- - - State ZIP,
--
Phone # (_—_) �` E-Mail
Subdivision
"l� . J
�r-----#"'
Authorized Agent -`�
City / r ZIP :X
-
❑ CW ❑ EW ElPTA ;a�g ElPTS
Phone # O _ River Basin
Affected
ElOEA ❑ El ❑ IH UBA N/A
AEC s :
I / i
Adj. Wtr. Body _ (nat /man /unkn)
❑ PWS:
Closest Maj. Wtr. Body
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 ler
avg distance of
max distance c
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
Shoreline Length
SAV: not sur
Moratorium: n/;
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 #
(Scale: / i j" )
PermitOfficer's Printed Name -
Signature
Issuing Date Expiration Date

i
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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
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)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(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 FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: , )=
Mailing address:
Telephone Number:
I certify that I have authorized�G Z,4A AS 1 L)SLSkjK Ef (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at
This certification is valid through \ �'—' c�S�Q (date).
(Property Owner Information)
&Wljei�
Title, co. owner or trustee for property
a- a--; �-_q
Date
=1
Telephone Number
�-� A 4r
Emai dress
RECEIVED
MAR 13 2019
DCM-MHD CITY

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