75652A_Whichgard, Ruth B._20191029

CAMA / DREDGE & FILL
GENERAL PERMIT
New ❑Modification ❑Complete Reissue El Partial Reissue
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
Applicant Name Car
Address 13lo car r � Y-1-) � ��<;, n i��►
No. 75652 94
Previous permit #
AO B C D
Date previous permit issued
// UC'
© Rules attached.
Project Location: County 0 hUWC{r1
Street Address/ State Road/ Lot #(s) Loi s �-13 iL q q
City 6l( n +Utz State_ C ZIP 2 i1i 3 Z F Sul r) , U o � ►col f\ t�d
Phone # ('S Z) Lj �, 7 s� �3 3 E-Mail W�^ t4p,cf cl1 ,4 Subdivision ro o n4 e)eA i E r
Authorized Agent 1< I I I <F
Affected El CW E4 EW PTA © ES N IFTS
AEC(s): 0 OEA ❑ HHF I H ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
CityFo Q-'Jor zip ; -�9 3 2
Phone # ( ) River Basin Chown o'
Adj. Wtr. Body be met, le Sos-k_hA (nat`'�l� nkn)
Closest Maj. Wtr. Body A l:nv mex r jc_ <= w-'i
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
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PermitOfficeVs nted Name
L.1, 41 /h
Signature
C-i Z/Z 1 /ICI
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, 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
Neuse River Basin Buffer Rules
Other:
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 DivisionofCoastal Mgt. Habitat Impact Computer Sheet
Applicant: �C%tr Permit #:
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
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternim acts
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
im act amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tem im acts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Shaur'G U &:1f6m
Dredge ❑ Fillpq, Both ❑ Other
%++
5 c' -,4-
( �,,
Dredge ❑ Fill ❑ Both ® Other
t( �
'5%-),e
rn Jh "' D Lnd
Dredge ❑ Fill ❑ Both (JX Other ❑
3, 2 K
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.nccoastalmanagement net revised: 02/03/10

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
2S� �Ik� �333
W l
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: J(Dn L g. (O, t UC-A-
v
aCL
at my property located at I (-� f ,� t � �� c ;`! L C. Ld aa—A
in C��Ck County. cP,7g3�1
I 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:
�tZ '�- 15) %1�4'Z'-e
Signature L
tC �
Printor Type Name
,Print
^>15
Title
)0l� l_
Date
This certification is valid through

I hereby certify that I own property adjacent to
property located at
(Address, o I k, Road, etc.)
)
on , in �.f_> , N.C.
(Waterb dy) (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 rill in description below or attach a site drawing) 1lo5 L.F � � h,c� V'AA� &-'06�Va
R4
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.)
V! I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sig ture
�u�'h G�ht shard
1'3i0 T yp N U., AzAn A
Ma'l' g Addresses
Weon, N c c2-7q 3 �2
City/State2ip
Telephone Number/email address
Date
(Adjacent Property Owne Infotion)
G
Sure*
/V
3Z
City/State/Zip I Z
A)L z 7
Telephone Number/email address
zsL4.Cz _:? -E�i
Date*
Revised Aug. 2014
( g )
*Valid for one calendar year after signature*

I hereby certify that I own property adjacent to
located at
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
's
4L
� ,,(�e oflf? pperty Owner)
property —
��� in (Address, Lot, Block, � Road, etc.)
N.C.
on
(Waterbody) (CitylTown and/or County)
The applicant h 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)
004avrl,�douj
' e-
�
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)
Si ture
M Gcl chard.
Print or T Name
Mal' Address �-7g3a
d N c
City/State/Zip
Telephone Number email address
Date
(Adjacent roperty owner inrormation)
Si re /-// //- �I-/� Y
Pn�}t or Type /Nme
/ 3 17��7���Z�� T ✓� 'or
�
Mailer Address
City/StatelZip
Telephone -Number /email address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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