Brokate, Randall

v
CAMA / DREDGE & FILL
GENERAL PERMIT
❑New Modification ❑Complete Reissue Partial Reissue
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 I SA NCAC
Applicant Name Project Location: County
Address ;r ei( Street Address/ State Road/ Lot #(s)
City State ZIP
Phone #rE-Mail Subdivision
Authorized Agent 1 _,`t ..�1 i A � �'"�►;) � ,�� city -
Authorized eA �-
No71620 A
Previous permit #
Date previous permit issued
--1 Rules attached.
ZIP
B C D
Affected ❑ CW , [n EW �i PTA AES �)P-PTS Phone # ( ) River Basin
AEC s : ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body � (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body % '"LG f ,1��`� ' is
Type of Project/ Activity
Pier (dock) lei
Fixed Platforn
Floating Platfc
Finger pier(s)
Groin length
number
Bulkhead/ Rip
avg dista
max dist
Basin, channe
cubic yai
Boat ramp
Boathouse/ Bi
Beach Bulldog
Other
Shoreline Len
SAV: n
Moratorium:
Photos:
Waiver Attaci
A building permit may be required by: ��c � x�' } Ott
( Note Local Planning jurisdiction) i I
Notes/ Special Conditions ' f - Xt., 4-1 kP UnA
Agent or Applicant Printed Name
(Scale: It =� )
See no�tSe on back r�eg�arrrdin�g�_Riiver B/a�sin rules. C
PermitOfficer's Printed Name
Signature ** Please read compliance statement on back of permit * Sig at re
9 °° -'�7� t/
Application Fee(s) Check # 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 howto complywith 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

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Marne of Property Owner Requesting Permit: I� LL
Mailing Address: ,Z y1 ' fj��l7- j -_
Phone Number:�„2
Email Address:�--
I certify that I have authorized t�AV/i /- ism �Z-
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development. p cz
at my property located at _ o?
in - C ZjgV A- " County.
i furthermore certify that t 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 Informati n:
(� Signs
Print or Type Name T
.'v-) , t.1 �- G'
Title
��'�
Date
This certification is valid through i i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Randall Brokate
`�s
(Name of Property Owner)
property located at Venturi Drive
(Address, Lot, Block, Road, etc.)
on Anderson Creek , in New Bern
(Waterbody) N.C.
(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
me. (if you wish to waive the setback, you must initial the appropriate blank below.)
l 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)
Signature
Print or Type Name
2,q4 tlf t�SC AP 1
Mailing Address
City/State2ip /
Telephone N tuber/email address
Dace
"Valid for one calendar year after signature -
_ t ,
Srghatnre *
Jason Nathanael Noble
Print or Type Name
450Q Emily Lake Ave
Mailing Address
Norfolk/VA/23518
City/State/Zip
928-271-0375
Telephone Number/email address
08/25/2018
Gate'= -- -
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that 1 own property adjacent to TIA-Q1 �
.s
(Name of Pro
property located at 'Z�t it Pk ►Ti tv� i�17 PeKY Owner)
on R L ' P r I- in
(Waterbody)
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location_
' 1 have no objection to this proposal.
I have objections to this proposal_
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
`C) (individual proposing development must fill in description below or attach a site drawing)
X
i
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.)
o wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Prope Owner Information)
Siteture '
CY( ✓1
Print or Type Nam
Mailing Address
C 2$5lov
�1 10/stateop
2?7Z - 725 - L10q g
ilk Telephone Numberl email address
7
Date
*Valid for one calendar year after signature` (Revised Aug. 2014)

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