Stone, Charles

f'
NO. 74418
CAMA / DREDGE & FILL
I
A B C D
,GENERAL PERMIT
Previous permit #
N,ew -_Modification Complete Reissue
-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.
F c'^~�
Applicant Name
Project Location:
County ( - -
(' ` y
Street Address/ State Road/ Lot #(s)
Address
_
City �! ' `l �r r State ' ZIP
-- l
Phone # (- )'E-Maid
Subdivision
Authorized Agent ) :"^ .. '_ .t4:3 :
/'
J
City / r '�
f
r...1 c ZIP
❑ CW ❑ EW ❑piA ❑ ES ❑ PTS
Phone # ()
River Basin
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body
,�� c: _
- '� (nat /man- /unkn
❑ PWS:
Closest Maj. Wtr.
rr : :Jil
Body
nRW — / nn PNA ves / no
Type of Project/ Activity
/ 00 r �� C4 � �r
Pier (dock) length
i
Fixed Platform(s)
Floating Platform(s)
Finger
pier(s)
Groin length
number
r
+ Y
s
�
i
Bulkhead/ Riprap length
1
avg distance offshore
.I
max distance offshore
I
I
'
Basin, channel
cubic yards_ f ra��
Boat ramp
�
�
I
Boathouse/ Boatlift
I
i
�
I
Beach Bulldozing
Other
i
Shoreline Length /
SAV: not sure yes no - -- f.
- - --- - }-- - - - -- - --
Moratorium: n/a yes no f
Photos: yes no -
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction),
Notes/ Special Conditions
J. �� 1
[ See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Signature , Please read compliance statement on back of permit
r�
Application Fee(s) Check #
Permit Officer's Printed Name
Signature/
IssuiJ Date txpiration 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
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)
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

DocuSign Envelope ID: 603D4EBC-IDOC-4A1A-966C-2D5BEFFEA235
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C �a r le S 'S'k r'
Mailing Address: 33fc�d UYtc
Phone Number:
Email Address: o: 0kA-
i certify that I have authorized !-'-�o Ah h .� U
Agent PContra'ctor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 4 ) k e,? ;7L A kqp
at my property located at t1j-2 cf tia Z/C-
in l.0 f ire f- County.
1 furthermore certify that I 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 Owryer Information:
Signatu
n'e--
Print or Type Name
Title
Date
This certification is valid through i

:�-
�'.�� �..,�� s�sz+..E�v.�,���:�« �4�,.,���,-� r.�._���h .3�„ � n,�r.��a;�.�, t>.�,�� ,��._� _ � r.�� .,..,, .��,��,�x__.,b w�...� �,��..xe�a��_3._ �_ , .,�, ,, �� .a. ���..,_�,.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C1'16i drS � '�t I
(Name of Properly Owner)
property located at q12 � L', [ ��• r- i.,dceis-lgia-vq t✓ P� /
(Address4, Lot, Block, Road, etc`)
on �)�SMCir,!Sl f in c, 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.
x 6 1 have no objection to this proposal.
l t 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)
10()0 y of 30 eXcAuaion
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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sigrlat�re � � fi
yt !1�f r �eS
Print or Ty a Name y�� t
t Ali :(3 M6u u 1n �^
Mailing Addres4
I -t N 14-^ i .) JA?_ AC
City/S ate/Zip
33,6- -S' -- o� a -
Telephone Number / email address
r
Date
(Adjacent Property Owner Information)
Siglzaptre * I f
e(HG#1G
Print otj Tl, e 9Smk��,); e'ctb,-')
i � L
Mailing Ad ress
City/State/Zip
Telephone Number/email address
1� Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

DocuSign Envelope ID: 8BD7B930-F929-4C6B-BC21-1E32D56E6EC4
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ['I
1 u r Ie,S , /-r y2 e- s
,(Name of Property Owner)
prc
lE
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locate
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)'
/()()()YJ3 *eXeAv/4I,ron
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)
Sigtzn,e
Ptint or Tye Name
Ming Address 7
t Gi y/CYS V.
City/Statel-3 , 00
Telephone Number / email address
Date
'Valid for one calendar year after signature*
(Adjacent Pr
4)erV Owner Information)
U1aiY.v''s �t�c- o� M.a,cew (,�•�
SIQnp �'iTLIS3BFtddoo ?f!fi1RzCr� l
Print or Type Nam
eCle"liQ
Mailing Address
r t'Ge t� t jet, 11f: .2 fl 73y
C/ty/stat m -
�— 3tc
Telephone Number / email address
4/9/2019
Date*
(Revised Aug. 2014)

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