Tedford, Mary

N
CAMA / DREDGE & FILL
71 640 A
B C D
GENERAL PERMIT
Previous permit #
_
New ❑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 r Cj�R ules attached.
Applicant Name y/ b �` i , ,'
Project Location: County `* C . °� III
�--7
Address IN.tU41!�
Street Address/ State Road/ Lot #(s) r
' ZIP =�
City f r t'. i' i State
—
f--j
ire f -'
Phone # ( ) ,��'' . LE -Mail
Subdivision T_ , i
Authorized Agent
City ZIP
❑ CW ❑ EW YPTA ❑ ES ❑ PTS
Phone # ( ) River Basin
✓ L{ Ise
Affected
Affected
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body ! ?
naf man unkn
A
El Pws:
Closest Maj. Wtr. Body
ORW: ves / no PNA yes / no
Type of Project/ Activity : 1
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_
Groin length
T
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel .
cubic yards tZ'`
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
� I
i
Shoreline Length -
SAV: not sure yes no
i
Moratorium: n/a yes no !
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: i X' t ' d) t of i'l l
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Arp
Name
Signature Please read compliance statement on back of permit
r�
Application Fee(s) Check #
r,
(Scale: .
P1 See note on back regarding River Basin rules.
Permit Officer's Printed Name 1r�
Signature
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:Hportal.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: P,4 ,4 2 V J-EA N tED FOIzD
Mailing Address: S L/ / 6 t ZA D E w 1 N D S R D
>y Ew a Ejz N , c C2
Phone Number: D
Email Address: r/l T T E D Fort Q to ff ej G tK4 I L- , ro pt'
I certify that I have authorized r /2 i C P,4 le E 2 , r�a c tv C ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: b e C: D G I N G
at my property located at S W 6 f 1?,4 b E Ly/ /V D S Q() ,
in C 12 A-V E V 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:
Signature
MAr2Y �tEAN fE 0 F02D
Print or Type Name
©W N Lr + Z
Title
Date
RECEIVED
This certification is valid through I I M 13 2018
DCM-► VAD CITY

.Ar
10

RECEIVED
JUL-13 2018
DCM-MHD CITY
ry
13U
V
�
ry
7
R
v
�
a
_s
r, i
!z
i
a, Lw
m
1
—I-
�
^
b
n.
r�
NO
n

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 1\,� A 2 `/ J E A N t E- D F0 IZ D
Address of Property: 5'-116 �2,4D �' L✓ �/V l� S 2 0 - Z/E� l . L.% 4"!571N
(Lot or Street #, Street or Road, City & County) ('U uN �'Y i /`/, (,
Agent's Name #:
Agent's phone #:
Mailing Address:
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.
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
available athttp://www.nccoastaimanagement.netlweb/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certfied 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' 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)
IV r xt.✓I
Signature
Print or Type Name
Mailing Address
City/StatelZip
,2 -�;3�-
Telephone Number/Email Address
3 / M•4,zc � go/ �
Date
(Ripar' Prop(erty� r Information)
v
ignature
S tsll;5-itl IYA 2 T
Print or Type Name
Mailing Address
�Ew 1?14!:-
City/State/Zip
Telephone Number/Email Address
RECEIVED
Date
(Revised Au JYZO 4 201
OGM-MHD CITE'

V

CNfICrn/-�,7/A.t/ p�PoPE/�7Y vwti&ems J T/�7�M�/V7`
I hereby certify that 1 own property adjacent to A7141,- Y t c.4A1 t ED Fe (20 's
(Name of Property Oar)
property located at /- -? D 6:71- / /V DJ 2 L)
(Address, Lot, Block, Road, etc-)
on Moll 6 Gr1Ps t (� r2 r 'f- tC in AJ L w f� G112 /V N.C_
(Waterbody) (Cityr'rown and/or Counfy)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
WAIVER SECTION
A 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 waivec�by
me. (ff you wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner InForrnation)
` :6c q k A4,\ :Je ct&C
Signature I F
Print or Type Name Print or Type Name
Sri/& 77.r-.4v '-I /A,14 S RID S- YIA 7`7,4 b 6-4✓/A/Q-( R
Mailing Address Mailing Address
/Vc 4 -' iie E1?111 S��G' Al I?�/1/ ,
CNy)Slan
Telephone Number/email address Telephone Nurnber/ernag address
Date Date*
"Valid for one calendar year after signature• (1
JUL 13 Z018
0CM-MHD CITY

F

A>
c
U
0�
1
h
R�
L%
7
�
N
ril
f
h
li
N
N
r
w
i
L2
o
.
^b
RECEIVED
JUL 13 2018
DCM-MHD
CITY

r
4,

Address 3-y I (D 'T r�d�W� �� J Date 1 co TLcn -z018
a4-4 PM
S hvre 1
3'14 3`ia
3N 3'la LA IN .51/4
wk
n
0
m
3g�4 '�'�a i 5��� •
co