73697A_Halla, Jr. Paul_20190815

Z CAMA / DREDGE & FILL
GENERAL PERMIT
YNew 'Modification ❑Complete Reissue ❑Partial Reissue
No. 73697
B C D
Previous permit #
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 Oc"
ff _ ® Rules attached.
Applicant Name((A r • Project Location: County 10 yN
Address ? d Ll tL4 u 16 !-},11 L.n . Street Address/ State Road/ Lot #(s) LA4 t; b
City ec;'kA cis State �-��' ZIP d l j� j� r ; _, I 0,11 L,\
Phone#(' `t)i 1 —(SIZE-Mail +-)tea flU�rry �G�is�a l�c'o,Subdivision I �1r;�� i �i1.1 i�<<n,
Authorized Agent X5 t�, `L City L•c i kn /tit\ ZIP 2
Affected ❑ CW 00 EW N PTA M ES L!7PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
ORW: yes /no PNA yes / no
Phone # ( ) River Basin
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Adj. Wtr. Body A 6t mar le Sour d ((6at /mean /unkn)
Closest Maj. Wtr. Body � 1_i� i'h<< r IC �Cu ti
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1%%OMMEMEMEMEME
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M. ®MEMEMMI
MIMMI MOMMEMMEMEMEME
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Agent or plicant Printed ame
��a
Signat e' "Please read compliance statement on back of permit"
(139
r
(_<-\ 14 � �OL" Yee.
PermitOffi r' Prioted Name
Signatu G 1
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 I) 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 F71 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

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: ?cL—\ 4cw a Permit #
Date:
7 3 (0 1,.E 14
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
rng h �^d
Dredge ❑ Fill ®. Both ❑ Other ❑
a �Gwst4
a p60 =oV
Dredge ❑ Fill ❑ Both ® Other ❑
900 -14V
3,00 S t4
Dredge ❑ Fill ❑ Both ® Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaImanaaement.net revised: 02/03110

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
ZZ
PAU 1�QL-LA fir.
�L, /Ae-r-ry l� l / 110 7 le
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11c- - r--- /0 167�q' / 6e,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA /permits9
necessary for the following proposed development: ��C'�9 `4 /'' `/
at my property located at L '
in County.
I 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:
�&Z 1-4a'
Signature
At,/ 101-44
Print or Type Name
yw �e
Title
Date
This certification is valid through % Z 1 � I I ZO

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to •qLl .�_..._ A* ��.rtv dornsrt
pro
(watorbody)
J%on,,
The applicant has described to me, as shown below, the development proposed at the above
1 have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
andiMuel proposing development must flit In description below or attach a she drawing)
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must b t back a minimum distance of 15' from my area of riparian access unless waived by
h 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.
or ati (Ad nt Property Owner Information)
(PropertofSignature/a// Signature* �U,a;CPft
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*Valid for one calendar year after signature=

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ADJACENT RIPARIM PROPERTY O MIRR STATEMENT
i hereby certify that I own property adjacent to P)gw— 144L-a 7r' 's
awwwwfv_ charneorl _
property located at Z Z `i
N.C.
(Wedy) ptyITown and/or County)
The appl'"nt has described to me, as shown below, the development proposed at the above
locatieo ,/
i/ I have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION AND/OR DRAV61NG OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below or attach a sits 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 wahre the setback, you must initial the appropriate Wank below.)
:l I do wish to waive the 15' setback requirement.
_ I do not wish to waive the 15, setback requirement.
) (Adjacent Property Owner Information)
(prae"r=- C s� (�)'
Signature - Signature* /
Print or Type Name
P 2 T A,26 Mot. ix Y f><ic(L,v
p /412 -Cj/
ToWhone Nwftbef
A0i/� ��� ,I, �t�
ad for one calendar Year sfler sign�
R o[., COM
{Reyind Aug. 2014)

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