Mitchum Jr, William (2)

CAMA DREDGE & FILL No. 73493 A B
GENERAL PERMIT Previous permit #
i . New - Modification 7-Complete Reissue —Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 0 /
77
and the Coastal Resources Commission in an area of environmental concern pursut to 15A NCAC / ' I I
anC?"-
- D� Rules attached
Applicant Name j "t - Project Location: County
Address
City State Y ZIP
Phone #(_- r�2,2-F m .1
Authorized Agent
Affected [I CW EW PTA 9�111FS 43 PTS
AEC(s): EJ OEA HHF 1H El URA D N/A
El PWS:
ORW: yes / no PNA yes / no
Agent or Applicant Printed Narne—
Signature Please read compliance statement on back of permit **
Application Fee(s) Check#
Street Address/ State Road/ Lot #(s)
Subdivision ----
­7
city ZIP
Phone #
River Basin
Adj. Wtr. Body am, z2 __(nat /man Junkn
Closest Maj. Wtr. Body >
r - - . L, -L." . - - - . - - - I Z
Permit Officer's Printed Name, -,'1__­.
Signature
Issuing Date Ex ration O(ate

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:
j Tar - Pamlico River Basin Buffer Rules ❑ Other:
El 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- jLL/fl111
Mailing address-
— 1 0 /Q
Telephone Number:
2&SIVOLLF Al C- z79-35
'-� ) q1 17- 36.52--
I certify that I have authorized )ent/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
41C,
-e-
This certification is valid through IL (date).
(Property Owner Information)
Signature
tillalt�m P 141reffcldl�ilc
Print or Type Name
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— t("
Title, co. owner or trustee for property
A,
D6 to
0 O 7`0-1-7-,,365J--
Telephone Number
Ck
Email Address

CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property kOwner
r pn� �0 V-A16
Address of Property. — - x
(Lot or Street #,Street or Road, City & County)
IDO A0 'd 1-113
Mailing Address:
Agent s Name 476
D C, 7-y-r ffC,
Agent's phone
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 de c%-W-di-dimensions *ded with this letter.
!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
:ior by calling 1-888-4RCOAST,
available at talman:-,II2,ment-n,etAveblcnil�stag-listi
htt :11www.nccoas L�
No response is ----Aor,-H the same as no ob, ction it ou have been notified b 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'frorn my area of riparian access unless waived by me. Of
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
r\
I do not wish to waive the 15' setback requirement
(Pro Aeowner Inf rmati
ig at re
at re
Tn-nt­or Type Name
?0 /&x 606
Ma,*no Address
city/statel'Zip
7-52 �7 �75'101
ielep�Z PeN�umbprlEmail Addres-'
(Riparian Property Owner Information)
Signature
IA
T -7
OM' or —TYPeName
Mailing Address
-US3 wc-
citylstatelzip
3 -
Telephone Number/ E-mail Address
i5a-te- It
(Revised Aug. 2014}

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #.-
(Lot or Street #, Street or Road, City & County)
Mailing Address: /v/Jo ?3
>
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 --re prcpcoiing. A..descriptiga or dray ,,1nc4,,vviUi dirnensions, must be provided with this letter.
­CA,I have no objections to this proposal. _ _ _ _ f 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 at htip.-Ilwww.nccoastalman"ement.netiwebfcmlstaff-listin orby calling 1-8684RCOAST.
No response is considered the same as no objection it you have been notified by Certified Malt.
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.
(Prope9ty Owner Injibrma wi)
z ZX/Z�
77, 7
�hf
-_IvAtnpmojg,
Print or Type Name
A_&
606
Address
f_Aqjjk1C 27
Ci4vState/zq)
elephoTe Number_ _I_Ef nW_a_#dA� Address
(1�41rian Pr Owper Information)
,)�J I gnature
C A
Print or Type Name
Mailing Address
citylstate"'Zip
C7 so, "7 19,
Telephone Number/ Email Address
— t� tD__3)1-1 -
Dow I T
{Revised Aug. 201,�;'