75651A_Perry, Clifton_20191023

k CAMA / 6 No. 75651 O B C D
GENERAL PERMIT Previous permit #
i�New JModification JComplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC r71-1 5�
r © Rules attached.
Applicant Name 'PC r , , i
Address + �, ��f. �'i�F4,_A Oc,wK Od
City r wl (-'_J { o__0V_ State NC ZIP QJ T-1
Phone # (?5 Z) Z(Of I L E-Mail
Authorized Agent
Affected ❑ CW ❑ EW 19 PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / mo 1 PNA yes / Rio
Project Location: County re
Street Address/ State Road/ Lot #(s)
E1c�OK Pd 5 �zog
Subdivision_
city h, ., Ha'J ZIP "7-79119
Phone # ( ) River Basin c Sft, o/a, /C
Adj. Wtr. Body C( rc, I 1 .)Fri n ( (t Je (rrek (n/at �yunkn)
Closest Maj. Wtr. Body l-u r t i t�rGjC Sou Q
Type of Project/ Activity l l \ A i N- r y, a 0 Ce rJ A Q YhA ^ aa�f ib� S j h
(Scale: 4 = 5v )
Pier
Fixe4
Flom
Fing4
Groi
Bulk
B.! i"
Boat
Boat
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A building permit may be required by: V1cUu) Ic ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions A r-kAaE (', .. n2 -) + I ..' , 'off 7 U, IT, N 60L nr- 1, V cyek
dcti 4 ►5 - �ra4 O�1
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Agent or Applicant Printed Name
ignatur " "Please rpe6compliance stater4Wnt on back of permiit"
j . , t j 09- — --- l IDAV
Application Fee(s) Check #
PermitOfficer'p 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 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 (910-796-7215) 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/ 1-888ARCOAST 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: CI4Orr R r � Permit k
Date: 10 f2 3 /1 ei
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq- Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
Habitat Name DISTURB
TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total in
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
hL'.�'GW G• Dredge
Fill ❑
Both ❑
Other ❑
L') 17-.55j+
4
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 Cl
Other M
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.necoastaimanagement.net revised: 02/03/10

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner: Clifton Per- r y
Address of Property:
Agent's Name #:
Agent's phone #:
4uJk,
(Lot or Street �, Street or Road, City & County)
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. A description or drawing. with dimensions. must be provided with this letter.
Y�K 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 Certified 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.)
1K
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
C f,RO VI Pe r-ry
Print or Type Name
I122 W. kittyN3vvk Rog
Mailing Address '
k+tg H,)akI N C 27999
CitylStafelZip
252 , 26 1 - Z912
Telephone Number/Email Address
(Ripari Property Owner Information)
7
Signature
Royd G. HgrrtJ
Print oil Name
5736 Lancelot Dr,Je
Mailing Address
V r-gi'rit'a Beach VA 23464
CitylStatelZip
5 OCe�(, vAe-_
Telephone Number/Email Address
Date
Date
(Revised Aug. 2014)

PERRY
i mNrEwNcE DREDGING
OF BOAT BASIN
MSTING
BOATHOUSE
Pent' Marine
er perrymarinem 252 202 8733
1064 Twiford Street, Kitty Hawk, N.C. 27949

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C61ton Pe rr u 's
Name of NoDertv Owner)
property located at/ 0 7 1 w k)'l I V qqvvA, o-
(Addiess, Lot, Block, Road, etc.)
on e4 ? rude,'S Creek , in kl'ft:� l'-1 awk , 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 hav6 no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
See, 7ft4che4 c raw,�d
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.
(Property Owner Information)
Signature
Ch*flov? Perry
Print or Type Name
1122 W K4ty H4W► Rodgl
Mailing Address
Kitty Hawk . A/ C, 2 7 94 7
City/Sta e/Zip
252. 2-61- 2412
Telephone Number/email address
Date
(Adjacent Property Owner Information)
Signal re
!~/lark -A Pe rry
Print or Type Name
i U (v - j rwi forW S-Jree7�-
Mailing Address
i-Aiwk; ", C- 2 r 91 q
City/St te/Zip
252, 202 • R 33 /mbcrry pzrr�.nar,jlc. corn
Telephone Number em it ad res
/d Z 2 --/q
Date *
*Valid for one calendar year after signature*
(Revised Aug. 2014)

PERRY
d
Z
d
v
i%(AWENANCE DKEDGING
OF BOAT BASIN
RMSTING
BOATHOUSE
Perry Marine
miler penmarine.com 252 202 8733
1064 Twiford Street, Kitty Hawk, N.C. 27949

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This map is prepared
from data used for the
inventory of the real
JL
• �J property for tax
purposes. Primary
r •�'� information sources such
as recorded deeds, plats,
wills, and other primary
public records should be
�rI11 f . Lk�ct� consulted for verification
of the information
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1091 W Kitty Hawk RD Owners: Perry, Clifton Griggs -Primary Tax District: Kitty Hawk
Kitty Hawk NC, 27949 Owner Subdivision: Subdivision - None
Parcel: 011179001 Lot BLK-Sec: Lot: Parcel 1 Blk: Sec:
Pin: 986619700950 Building Value: $0 Property Use: Secondary Improvement
112
2 KA� f1c, .z1C 2,1 Land Value: $48,300 Building Type:
Misc Value: $6,800 Year Built:
r14, Ht`"3K t e Total Value: $55,100

CAMA / -_ DREDGE & FILL / 4
GENERAL PERMIT Previous permit#
3New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name C hi:�Q, pe f ".I
Address__!-', aA U,i c ,
City - +s t State for ZIP ;?-I- (i L.;
Phone # t ? Fax #
O
Authorized Agent
Affected ❑ CW ❑ EW 06 PTA L ES ❑ PTS
AEC(s): 11 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / mq PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
wi
Subdivision —
City +;
ZIP
Phone # (�) River Basin -, . , , J
Adj. Wtr. Body (eat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature /— Please read compliance statement on'back of permit"
Application Fee(s) Check #
Permit Officers Signaw' re
Issuing Date Expiration Date 7L!L_�
k�§�y 14uk,�
Local Planning jurisdiction Rover File Name