73870A_Woolwine, Jr, David F._20190917

XCAMA / 0 DREDGE & FILL
�. GENERAL PERMIT
❑New ❑Modification El Complete Reissue ❑Partial Reissue
No. 73870 �,p-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 RL 0 0",
M Rules attached.
Applicant Name o'u'%C E w- ac&_ , r
Address (U_,� 61u n(} L A T . � ,
City \lot I(Az-,w+\ State Vc, ZIP
Phone # 80 —U(c49 E-Mail `l) .ii
Authorized Agent Tr 0. v %`s
Affected ❑ CW X EW q PTA ®ES [RPTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / 'n PNA yes / e
Project Location: County C hcx UGC in
Street Address/ State Road/ Lot #(s) Lo}
-oj'o Subdivision
City LdeVvjdo ZIP :� / 9 3 C
Phone # ( ) River Basin
Adj. Wtr. Body C V I "Ck A t :'19 f (nat [,mean /unkn)
Closest Maj. Wtr. Body Y) '- c I � C: ,• ,A,A
III, um
Ing Platform(s)
r pier(s)
;in length
number
length
avg distance offshore
max distance offshore —
cubic yards
ramp
house/ Boatlift
h Bulldozing
EMMMMMM
ME
NINE
No
No
_��WMMM
Agent or Applicant Printed Name
sigaature Pleaseread compliance statem nt on back of permit
LILU, GU
Application Fee(s) Check #
Permit r' Printed Name
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, certifythatthis project is consistentwith 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 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/ 1-888-411COAST 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: D'-V t3 1 �Y Permit #: 7 � , r] Q
Date:
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
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp imnnrW
imnnnt amniint)
tomn imnnntel
--.\
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanauement.net revised; 02/03/10

AGENT AUT
HORi2 TION FORM FOR PERMIT APPt-ICATiC)N5
pwner Applying for Perm ts
`' v
Name of Properly
Mailing address: b <"
J Telephone Number*
I certify that I have authorized---�-
' r. and obtainiflg all CAMA permits
to act on my behalf, for the purpose of aPplying
j necessary for the proposed development of
_ i�- E -�
at my property located at �
This certification is valid through
(f' oparty Owner tnf rrrtaison)
`� Signa#ure
F's ar Type Name
Title, c,
'I'D�-
Telz
r trustee for property
(J ( u
, -rnber
tAj Lj (U.1
Tr-1 11_Ss

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J1 h U k iN bs 0b LLA-%I A-`ot Is
(} � (Name=perty Owner)
property located at t `-� V 4r"' %L1V C:4
(Address, Lot, Block, Road, etc.)
on v VLtl --UL in %rl�.r' N.C.
Waterbod ( y) � `(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiop
��t �' 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)
(-AJ 5-e .;
-, -75-
L--
34.,
�� G��lA GttR\„
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.)
` I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
tgnuz ur e
Print or Type Name
Mailing Ad ress - i
i St te/Zip '
Teleph 77eNuq7berl email address
Date
*Valid for one calendar year after signature*
(Adjacent Property- Owner Inform tipn)
Sig at�ure
Print or Tyke jiarwe�
7 G o', v' u" J✓t^?etA
Mailing Add ess
CitylState/Zip�
y2-2)-�
Telephone Number/email address
Date *
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to D L v , i� � � - �� � � ^ =� s
Game Property Owner)
property located at ``t ( 9 u C jiGt-' ,� t )
(Address, Lot, Block, Ro;t, etc.)
on ( ,>ta, t-.% I�-kiJr"tFL ,in i'i �s iL4-..i N.C.
(Waterbody) (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 lift in descriptlon below or attach a site drawing)
1 f ��r t 9F�'zrtw+sc.�i nlcc
p240
f
� Ej r•�.d, •.-Y�
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.)
do wish to waive the 15' setback requirement.
�R I do not wish to waive the 15' setback requirement.
)party Qwner Information)
Myiling,Address
i,tf_ t�f4. h S c.F`(
�,.rc .�ecwcrN
Telephone Number / email address '
Dare
(Adjacent Property Owner Information)
Sig a
Pri t or Type Name
4 in Address
C7ty/State%Zip`
-2 I
Tetephorye Number/ email address'
(Revised Aug. 2014)
"Valid for one calendar year after signature`

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