Flye, Chris

-CAMA / DREDGE & FILL
G_ ENERAL 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
State
ZIP
Phone #j 7'' l
u
E-Mail
h
Authorized Agent ?
t
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ElCW
❑ EW
n PTA El ES
ElPTS
Affected
Affected
❑ OEA
A
ElHHF
❑ IH ❑ UBA
❑ N/A
❑ PWS:
ORW: yes / no
PNA
yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
No71682 A
Previous permit #
Date previous permit issued
7 Rules
B C D
City--- _ _ ZIP
Phone # ( _) River Basin
V � r Adj.
1 Wtr. Bod ! '" Y A_/man /unkn)
�
'
A.
Closest Maj. Wtr. Body J6' " j • X.3f L"'k
Type of Project/ Activity
(Scale:
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) c g
Finger pier(s)
._. .. ............--- - - — -- ._ �.._-......-.__ ........._ .
...-.. -...._
Groin length
number
Bulkhead/ Riprap length i
avg distance offshore
max distance offshore-,,'
Basin, channel
cubic yards
Boat ramp
I
Boathouse/ Boatlift
Beach Bulldozing _
Other' ! r'
Shoreline Length f
SAV: not sure yes no
ALL
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no j
A building permit may be required by: t. t" r �/ ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions (.
Agent or Applicant Printed Name
Sigq urea "Please read compliance statement on back of pee; .
4
r:).T
Application Fee(s) Check #
Permit OfficersP�ri--n�ted�-ame
Signature
A2
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 comply with 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/ 1-888-4RCOAST 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 &THORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: i��v ► s�•A� w y�/��
Mailing Address: j a 4 V+'r,c i,;A ►',► L�
Tr ,tr; H c Z r tc i
Phone Number: z r L - (.?I- LYj 7
Email Address: c FI y4 r► e. I r, k,
I certify that I have authorized,.
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:i>cpe_-t
at my property located at 104 ; �t .` N ; . L �. r Tre'.�x r' 40J Xj
in C r •yt,, County.
I 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 Owner Information:
��Lw-
Signature
Print or Type Arne
40W &,,& -
Title
7 1 1r / 1 y
Date
This certification is valid through _�1 30 1 l Y

a . . if

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C41 ,SLY _j(��r1jL
Mailing Address: 1 0 4 V
'r/�,j wooAtr He j�i't6L
Phone Number: Z t L - 4 33 ZY3'7
Email Address: e., I. c
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 104 V Tr4,...x LA)144 dief ,
in C r+►yv, County.
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:
w•
Signature
dA V, � i "t 4 I.V, W. j�71 14-
Print or Type N me
dow &..A.—
Title
7/ !., I / Y
Date
This certification is valid through �_I 3+ I 1 Y

DAMSON OF COASTAL OAANAOEMEM
ADJACENT PJPA'Mk PROPIRTY OWNER *OTWlCAT§OkWAPnPt FORIA
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY
OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: (M r i f sAO t t- W. rl l
Address of Property: (•a VirS r��'. L`` , Tr/u.�- t�..Br, Crowe..
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address:
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 description or drawing, with dimensions, must be provided with this letter.
I 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
availableafhttp://www.nccoastaimanagement.netlweb/cm/staff-listingorby calling1-888-4RCOAST. (!�
No response is considered the same as no objection if you have been notified by Certified Mail.
I
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 J'
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 formation)
Sigiwfure
Print or Type Name
1 &4
Mailing Address
'(rva.t • ,.Q s A/ C
City/State/Zip
I ,'s - & 31.1,11 Lo
Telephone Number/ Email Addr ss
,Is�l,rr
Dale
(Riparian Property Pwner Information)
�A_K�_V3_
Signature
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Print or Type Name
jy
Mailing Address
.
+may v(,%f.
1�t-,
City/ ate2ip
�,.!
Telephone Number/Email Address
Date
(Revised Aug. 2014)

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