74086_Long Tran_20190919

0 - -is ,
CAMA / DREDGE & FILL - D-# EOtt15to No. 74086 ,
GENERAL PERMIT Previous permit # A N fa °
New Modification Complete Reissue Partial Reissue Date previous permit issued Al /4
As authorized by the State of North Carolina, Department of Environmental Quality `v`�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
IZtRules attached.
Applicant Name "Q°�� T' / Project Location: County 3E'3-v1--012-1-
Address /69.J -� '' ' --''`---) - ,,,e • Street Address/State Road/Lot#(s) o 7 / 5A: _. 7 -',-.
City 3,47---�' State " 1 C ZIP S /4.93 �a 2'' / ,
Phone # (=y''(2) 5 `d' Z/='3 E-Mail __ _ Subdivision '3A y v.C LA-) -
Authorized Agent 14140-7 y $'',-' - City Cy`-''7-' _ ZIP
eW NIEW .IPTA DES ❑PTS Phone # ( ) _ River Basin' '' -2 - ,--1 iJ
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A 2
AEC(s): Adj.Wtr. Body/f''"14-'10 �'t "� c(r an /unkn)
❑PWS:
Closest Maj.Wtr. Body L'''Vv
ORW: yes / no PNA yes / no:.)
Type of Project/Activity/sv .T e' Pit/ . ? -": c- x 16 p,..--T•-Pw-"'
X. / b _ t is'vr fry /I 1-2r /--. L,,.--1( U 1 , . ,-� Ld n r—, ;_I; (Scale: 1 Z O ' )
/
Pier(dock)length�v -�' 6 ' �I-'�.r�-� L/ f�'f'
Fixed Platform(s)/6 Y , h. I T-- r , 0 . , —6
Floating Platform(s) ____.- X J6
Finger pier(s)5 y,4 , V I//(Q
E ar..., 6rer� a4vt i —t
Groin length .
number J 4
Bulkhead/Riprap length d + ' /h
avg distance offshore i - _ - . 1 _. / /j. Y/Z I/ 1 . ;
max distance offshore ,3,...," r 1
- x/ r 6. I P/e.g. . �/+
Basin,channel_ L s-✓,f-r-. 1'J l i '
cubic yards j
Boat ramp /
Boathouse/Boatlift 7/? > 1- 1 1
,51,,,►.-)`A .
f Ill, 7
Beach Bulldozing _ I _
1 f-�r'Z� S 1 ' , �. • RECEIVED
Other lJ-� b
— - —_ _ SEP 2 l 2019
/ j
Shoreline Length La t i
SAV: not sur yes no _....... -I- .. _._, 1 ._......—� _ �_ _ —
Moratorium: n/a yes I (
17
Photos: no --_ L i 7� ,) �l
-vl I p
Waiver Attached:
A building permit may be required by: , P'y/rtkAl`r ePG ' , See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions ' '/ '_�1 P"y . - r--alli /oO -771,
r7---L ,.,._-f c,,,/•1 vM ,.4Y7 z ' wrY�
/ t .
if,//7/, ' ` '`� /cam y
E-t/;7 JP
Agent or Applicant Printed Name / Permit Officer's Printed Name
f I ���
Signature "'Please read compli ce statement on back of permit a'* Sign�'Signature'J
i �' 'C�-�° ,_5 _.3 Y --La/ .1 / 1 . 1-0 2- 0
• 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 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(910-796-72 15)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/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret, Craven, Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan, Currituck, Onslow-South of New River Inlet-
Dare, Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of PropertyOwner Requesting Permit: L4)6,k, `�`'^
q 9
Mailing Address: Le4B 9 iz R el
li ..- i'l t•ic -251108
Phone Number: �4'0 - gtA" - Z I a 3
Email Address: lOz5 t'rA h • 'f.:th "\crOr1 Sul '1 1147.44 I , CO"
I certify that I have authorized j u L 1-(. 44' 11&•K ( 1 fS diC
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 16413 ollUt-tJ 6 12,w C. �--6 U ,
in County.
l 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
L h ✓vim
Print or Ty, e Name
Title
Date
This certification is valid through I I

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 37 'c e44. ,.I 's
/ Q (Name rc,ogerty Owner)
property located at ! 4! ,g,..97(L1 L-J
(Address, Lot, Block, RD., etc
on /' L,/ed 17 r'C. , in / A-frj li-- , N.C.
IUaterbody) (CitylTown and/or County)
The applican s 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 fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 t waive the setback, you must initial the appropriate blank below.)
i
AK:wish to waive the 15' setback requirement.
Ike-
do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature, '-I Si41-":....id.
/ //
lath7r� l� iiiiL:�
Pri t or Type Name t Print7/yam N e
Y 4:41:,,-,-.3 ;7(--/
Maili dress Mailin• ;•• - s
Cit /State/Zi p City/ ate i
Telephone Number Telephone Nkm r
?//y
Date Date
Revised 6/18/2012)
1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iocati n.
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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
(Property Owner Information) (Adjacent Property Owner Information)
Signature Si nature
L., ` (Gin �11 S 5� -Tkv`(47k-5
Print or Type Namq. Print or Type Name ,, n
/44‘11-4A)*) , </ I
Mailing ddress\ G o Mailing Address /
City/State/Zip 2...tto t ooy���O 3 City/State/Zipf
O5
Telephone NumberS/ l Telephone Number
Date Date
(Revised 6/18/2012)

NC'Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: L evj[ T ,J
Date: /q 6EP7'Er13EYL 20I 9'
General Permit#: 4
Describe below the HABITAT disturbances for the application. All values should match he name,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft FINAL Sq. Ft. TOTAL Feet I FINAL Feet
(Applied for. (Anticipatedfiral (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Habitat Name Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or lem p restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
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Dredge❑ Fill❑ Both ❑ Other ❑
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Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
1 I
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 Cl