75642A_Black, William_20191022

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CAMA / DREDGE & FILL NO. 75642 g C D
GENERAL PERMIT Previous permit# `J
E�New Modification ❑Complete Reissue J'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 I SA NCAC I
a] Rules attached.
Applicant Name W , wi o m black
Address >). O. 60X '7 $5
City : n+On Statey c ZIP ;2-75 3 ;c
Phone # (L'i Z) `i $ L " 1491 E-Mail
Authorized Agent
Affected ❑ CW K EW ®' PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / �n�
Project Location: County C, howan
Street Address/ State Road/ Lot #(s)
1 3 2 Cou rdYT C1�jb Df
Subdivision
City L,,- 4-8n zip ;Z7g3Z
Phone # (— ) River Basin a o 1 c R k
Adj. Wtr. Body 1 be Mar 40 _)D_% )I 1 at mean /unkn)
Closest Maj. Wtr. Body 0(bue Wa f (f Sa,ryl
Type of Project/ Activity -sl 6
(Scale: 1" Ot )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length`
nuMber
Bulkhead/ Riprap length
avg distance offshore
max distance offshore _
Basin, channel
cubic yards -
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length L.(50
SAV: not sure yes
a
Moratorium: ri al yes
no
JJ �
Photos: fs_�
no
Waiver Attached: yes (Pi)
A building permit may be required by: t O'lp;.')C1 n Coa r / Fotel -ion
( Note Local Planning jurisdiction)
Notes/ Special Conditions
L oz, C. ),C—
Agent or AppflCant_Pri
Signature ** Please read compli nce statement on back of permit**
�00, �,'iy
Application Feels) Check #
❑ See note on back regarding River Basin rules.
Ln � IC�' i OLA6
PermitOffi, 's 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: WA\, c,-m &aek Permit #:
Date: \0 ( a a / 19
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 includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp im acts)
im act amount)
temp impacts)
amount
Dredge
55'rt-
❑
Fill 55
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 M
Both M
Other 1-1
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge [I Fill [I 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: 02/03/10

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to bi'1 11;4 _ P�r'��
-- 's
Property located at
(Name of Property Owner)
CALt,6 J r; 4 c—
(Project Site: Address, Lot, Block, Road, etc.)
on 1 be, -,in .tr> _J J 6A6,C-.e-,J
N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: vipt
Mailing Address:
Agent's phone #: yJ j
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT Ondividual.proposing development must rim in description below -or attach a site drawing)
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. Correspondence should be mailed to 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. No
response is considered the same as no objection if you have been notified by Certified Mail
(Pr e r of n)
Sig(Adjacent Property Owner Information)
nature Signature*
MARILYN FRAZIER
rrnName Print or Type Name
on m X
138 COUNTRY CLUB DR
Mailing Address
Mailing Address
Crty/State/Zip
2-5z- 14-1 l
Telephone Number/ Email Address
�� O�.jo�trJt�Zol�
Date
*Valid for one calendar year after signature*
EDENTON NC 27932
City/State2ip
Telephone Number/Email Address
Date"

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to W'A\ �&— \N�obl , 's
(Name of Property Owner)
property located at L C o"nj,rti .ri�—
(Project Site: Address, Lot, Block, Road, etc.)
on �c *�arl� .Scxc�v�l in 54,16-a✓ ) rJ � N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: Vl et Mailing Address: TJ >�
Agent's phone #: %J%r
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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. Correspondence should be mailed to 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. No
response is considered the same as no objection if you have been notified by Certified Mail
(Pr O f n) (A 'scent Property Owner Information)
Signs Signature*
W; C. S_ l vc�--G tc__
Print or Type Name
P o_ pc�,O* S23 S
Mailing Address
City/State/Zip
Dsa- Li sz-
Telephone Number/Email Address
1©j I19
Date
`Valid for one calendar year after signature"
PATRICIA TIMBERLAKE
Print or Type Name
130 COUNTRY CLUB tb,R
Mailing Address
EDENTON NC 27932
City/State/Zip
cel6,2-33y-77S8'
Telephone Number/Email Address
/D-ai-r9
Date*

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