Leroy, John

r / No. 73951
LAMA / [ DREDGE & FILL A BC D
GENERAL PERMIT Previous permit #
Nev: -Modification Complete Reissue I -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
Project Location: County_
Address f..) l /`' / r, t' Street Address/ State Road/ Lot #(s)
State 41�ZICity_P ,•.�---t %�`��. � �.�_.�� �, 1. �a � �i!
Phone # ( )_-
` ,) ' .
- �� E-Mail
Subdivision
`7
/
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City c - ' !' `� ZIP
o�
Authorized Agent
1 ' > r
❑ CW
.OfW $RiA ❑ ES ❑ PTS
Phone # (_- —) River Basin
Affected ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body__
nat
man /unkn
AEC(s):
❑ PWS:
Closest Maj. Wtr. Body
nQw o� / —
PNA ves / no
Type Project/ Activity
of
(Scale:
)
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
---
-
--:
--
!
-
I
j
j
A
/
i
Boat ramp
Boathouse/ Boatlift
i
Beach Bulldozing
Other
-
...
!
-
I
Shoreline Length It7
SAV: not sure yes no -- _
Moratorium: n/a yes no
i
Photos: yes no _ — -
I i !
Waiver Attached: yes no ------
A building permit may be required by: ❑ See note on back regarding River Basin rules.
( 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 #
Permit Officer's Printed Name
Signature
I el
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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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
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)
Revised 7/06/ 17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Sohn Lemy
Mailing Address: 6404 Old COVE; Road
Emerald Isle NO 28954
Phone Number: 5f30
Email Address: ilPrnvhrnnkski lshman r-nr 1
I certify that I have authorized Harber Contracting Inc
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development; e
atmy property located at 6404 Old (.C)Vt=- Rd
in Ga,4ero} County.
cur
l furthermore certify that / 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:
IRS
-nz NO
Signatu
Print or Typp N e
-----
Owner
rltle
Liz
_.....Oahe
This certification is valid through 12 / 31 / 19

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to John Leroy s
property located at 6404 Old Cove Road (Name of Property Owner)
Address, Lot, B�oock, %�o d etc.
Ern ald�sle )
on Bogue Sound , in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
4I 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)
' WAIVER SECTION
I understand that pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
musLbe set b a minimum distance of 15' from my area of riparian access unless waived by
me. f ou rsh to waive the setback, you must initial the appropriate blank below.)
%J►j/ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informan)
Glee
Si atur
A o
Print/or Type Name
fling Address
City/State2ip 9
2,5"2 — Z? /5-
Telephone Number / email address
03 - iY - Zo♦ 9
Date
`Valid for one calendar year after signature*
(Adjacent Property Owner Information)
s e tVogers �Tft At_ mac,-,cr�S
Print o Ty e Name
CA06 C-6 Co w .
Mai#Rg Address f
City/StatelZ
Teleph e N mber/email addre
Date
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to John Leroy
I
property located at 6404 Old Cove Road (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on Bogue Sound , in Emerald Isle 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)
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
/mg. (if you/wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner, Information)
SDI '1Ylrroy S fnulu'�
olfin eel
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number/email address
Date
Print or Tge
Nhailing Add s
te/Zip
r V— c
Telephho 7 u�rt rl mail address
Date *
(Revised Aug. 2014)
"Valid for one calendar year after signature"

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