Knight, Erin

CAMA / ❑ DREDGE & FILL No 71667 A B C D
-. GENERAL PERMIT Previous permit #
DNew ❑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 I SA NCAC Rules attached.
Applicant Name Project Location: County
Street Address/ State Road/ Lot #(s)
Address i
City # t ^Y--� 6'i n State_' ZIP zo_
Phone # E-Mail . Subdivision
Authorized Agent t 'f City ZIP_
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( __) River Basin
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A /
AEC s : Adj. Wtr. Body___ (nat /man /unk�
I] PWS. Closest Maj. Wtr. Body
ORW: Yes / no PNA yes / no
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Agent or Applicant Printed Name
Si nature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Printed Name
WON
Signat e
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
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:
Mailing Address:
Phone Number: C LS'� 2S _ A l91
Email Address: K-C1 VkCA--'c�P ` Cam
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 ,J- \j I—r- t'
in ^ t%Q�\/f�11\) County.
J 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:
ign ture
'it( - h�
Print or pe Name
Title
Date
This certification is valid through
"Ec'Er,
RECEIVED
JUL 2 4 2018
DCM-MHD CITY

�b -
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
�.��1�, Lv► G�32
II I IAlll lilt I� I II I! I I II I III I I II I I I III I I I I IN
9590 9402 3402 7227 4006 54
2. Article _Number (TiaRsfer from SarVke labs!)
701L 2070 0000 1605
Ps Form 3811, July 2015 PSN 7530-02-000-905
A. Sig
X
❑ Agent
Addressee
B. R vjlei'd11by (Printe�d7Name) C. Date of iKe
' T '
D. Is delivery address different from item 1
❑ Yes
If YES, enter delivery address below:
❑ No
3
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
❑ Registered MaUT1°
❑ Adult Signature Restricted Delivery
El Registered Mail Restricted
❑ Certified Mail®
Delivery
El Certified Mail Restricted Delivery
Q Return Receipt for
❑ Collect on Delivery
Merchandise
El Collect on Delivery Restricted Delivery
Signature ConfirmationTM
Insured Mad
0 Signature Confirmation
I Restricted Delivery
4489
Restricted Delivery
10
I
Domestic Return Receipt
RECEIVED
JUL 2 4 2018
OCM_MHp C17y

#
First -Class Mail
Postage & Fees Paid
LISPS
USPS TRACKWG
Permit No. G-10
9590 9402 3402 7227 4006 54
United States
Postal Service
your name, address, and ZIP+40 in this box• I
6W on / �jL Z'�: O

ADJACl;—RIPARIAN PROPERTY OWNER STATEMENT_
I hereby certify that I own property adjacent to �1211.1 -+ M
1 S C;akws
Property located at 24U (Name of Property Owner)
on N 1ST @ \(F Q (Address, lot, Block, Road, etc.)
in ►.JEt i �,— �� P rFN.C.
(Waterbody) (City/Town and/or county)
The appiir.'0 has described to me, as shown below, the development
loca r y- P proposed at the above
I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposfng development mustfrll 117 description below orattach a site drawing)
RECEIVED
JUL 2 4 2018
L)CA& VI yp Ct7y
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, flit, or groin
must be set back a minimum distance of 15' from my area of riparian access unriess waived by
me. (if y i to waive the setback, you must ial 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) (Adjacent Pr O Information)
Si bore Si e* ,
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Telephone Number! emad address Telephone Numberl email address
Date Date*
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'Valid for one calendar year after signature" (Revised Aug 2014)

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