74104_Lynne & Bill Pederson_20191107

LAMA/ ❑DREDGE & FILL .Ic4 W 4- 4 8 No. 74104
to A C D
GENERAL P RMIT Previous permit# ? 3-
�� ❑New Modification i Complete Reissue ❑Partial Reissue Date previous permit issued ' .H i
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 5A NCAC Q ?H.I I£70
ff ❑Rules attached.
C
Applicant Name Y 4/1/` 43)L 1 Pr 1�E RS O N Project Location: County PAti..I 1 c., (O u A1 Ty
Address ?CI 7 IAI k WI C t b 1 . Street Address/State Road/Lot#(s) 7o/ 7-
City0 1t:AITAL. � 1
,/ StateC. ZIP295 1 Ff' 4c; L)R
Phone#(!SL) 2L /- 37 7$ E_Mail Subdivision
Authorized Agent City 0 K 11=^1TA C ZIP 2 8s7 I
Affected ❑CW ❑EW ❑PTA WS OZPTS Phone# ( ) River Basin A.) U I
AEC(s): ❑O� ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body 077:u C RC El( man /unkn)
❑ Pws. Closest Maj.Wtr. Body N f— U..Z R I VE.
ORW: yes / no PNA es5/ no
Type of Project/Activity A +1-IoIQ(2,c ') (-D d C LI t )(1•1 iA1i
(Scale: )
Pier(dock)length
I I
Fixed Platform(s)
Floating Platform(s) ,� II
, I I I ' liii
I
Finger pier(s) MN
Groin length II Illri I j
amber driP Ripraplength $ 7Oi ■■I■■■ ■��, ■•ingippiliolpii
1■■si■■�■ ■■
avg dIIHhIIIItII ..
■� ■■�■■■® ■ rNIIII!!I!IIIIIIIII■■® ■■�■■■■■aa■■■
■I ■■H■ ■■ : Mpw i _ _ pu . ■ sass ■■■
cubic yards �� / ��
II
Boat ramp
Boathouse/Boatlift
I
1111111
Beach Bulldozing IiI
Other I j — -I 1
mIll ; II II 111
SelineLthD 0 I ■11liiit
SAV: not sur yes no E ---
Moratorium: n/a yes 410iimmi■m■■■®■■m i ■■ ■sass■■■ ■■
■Photos: yes no ■■ ■■■■ i ■ III I -
Waiver Attached: yes I . ' i
A building permit may be required by: PAP1L.t C O C ru n/T./ . H See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions < r (y 711 .J I O©, N0 (,J E ILA NQQ F /C( AL t o tA(ID.
ifiliv Kr v ie 1-IA
Agent or ApplicargPrin N me Perinitoff er's " ted Name
Signature **Please read compliance statement/on back of permit** Signature
4yo1).00 I )(, f n)0J Zoll Y NlARt{) 26Z01
Application Fee(s) Check# Issuing Date Expiration Date

(42JCAMA/ El DREDGE St FILL
'
No. 73963
GENERAL PERMIT Previous permit# A B CC ID
, New [T]ModificationDComplete Reissue LiPartial 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 5A NCAC
it Rules attached.,
Applicant Name ,„ 7 11/II ti 1'(.' ''t: ' 2 Project Location: County ... 1: t
Address /,,-,,,' -/ i : I RJ I, \ Street Address/State Road/Lot#(s)
/1 t- , -1 I City ; ',, 1 1 , , , ,' ., State `,i ZIP ,,-;i
' Phone#( , . )„,,/,,1 , f,- / E-mail Subdivision — -:
---r— ,,,,,,,,,. ,
Authorized Agent _;, ',, ' , ' ; ' ,' \ ' t!e :1:, , City ZIP ______
. ,
0 CW LiEW LI PTA CIES [1PTS Phone# ( _ ) River Basin I 1( i
' Affected
L.;OEA Li HHF 1.3 IH 1.3 USA 0 N/A ,. ,, ,
..,,
AEC(s): Adj,Wtr. Body '.. ' ,. ,, \(' ,,, 4--,„ _f(nat[man Junkn)
ri PWS:
. ,f.f ' ' ' a - -I
ORW: yes / no PNA yes / Closest Maj.Wtr.Body no
, , 1
, f - -Type of Project/Activity i , , .
, - --, , I ,- ,
. . ,
(Scale: I
Pier(dock)length, ...
, . . I...•''. '7 7 1,
Fixed Platform(s) ' . ; i
Floating Platform(s) ..
1
! , ' I ' i• ' - i
Finger pler(s) ,- -i I ' ' : ' :
I .
Groin length . i ;... .4..
, :.
, kymber — . , _ ., ,
:
2,-, ' ' , ' - r
''., 4\ '' : ,.1 ,' i- '-':'- I,/t'- I ' •Bulkhead/Riprap length ' . ''' • ii
....„ ... I * * II. '''
avg distance offshore12'' ' i 1 / ** " i
max distance offshore .:/, ;, , ;',
Basin,channel '.. - •
. -,l .,
:
1 .
i ,
'"
„
cubic yards ,
i ' * '
Boat ramp 1 „_2________. ..4. I
-7---
I V_- .,.. i !' ' ,, ' ..' 1 i
Boathouse/Boattift „.. ' :
.
,
Beach Bulldozing I " I , . -Other -- i ' ; ; • ' ! 1\4 1 i 1 ' ; ; ; , 1
. :-
; •,,,,' 1 ; ; • 1 ; i ; 1 , ',: ,, .
•
'. ; ; ' 1
',,,r,,
. 1-
Shoreline Length .
. , *
SAV: not sure yes i no'" : : ' . . ,
- . , : I i 1
. .
1 ;
' '
Moratorium: n/a yes i no I i1 " : : i ' ' I‘ ' * I ,..12.Photos: yes.1 no/ i , ; : ' ; I i ' .
yes it 17)5, i ,i,,,, ,
Waiver Attached: 1
A building permit may be required by: ,
: ,.. ,; .
i)
Pl See note on back regarding River Basin rules.
. , - ,
(Note Local Planning Jurisdiction) . , , 1 1 i/ I
, -k , - „
' V, ff' ,, £ i ' t . ! -
Notes/Special Conditions 1 1, ' 1 ,
' ' / I ( V(- '''t :-.'I I iri
'-1 1 - i i
,
" 1
Agent or Appli t Printed Name Permit Officer's Printed Name / ./
,
Signature **Please read compliance statement on back of permit** Signature .
/,- -- -1 i 41'' )' /, (/ i / ,.„ -//-.Application Fee(s) Check# issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
1
Name of Property Owner Applying for Permit: (. y ov I r(,eq- e'\
Mailing address: 70) �7 V'``v-`^t o v3 4
1. 71
Telephone Number: 5') t���r� + 61
I certify that I have authorized O A PI •c•NV t'.• (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of j\je.vJ vv,%'c)", \\(\s‘e",
at my property located at 70 17 ,.‘;s wvw\�� �� ch , ,'\v N6, 1(?,57
This certification is valid through (date).
(Property Owner Information)
z
c-
i Signature
Print or Type Name
Title, co. owner or trustee for property
X
—__-- .._._Date
U 7 75
Telephone Number
6a\o lCvyv L c 9►>vsay.(0
Email Address
I

I
imu.1 141 r N.
,. , *.. /4:, \\..,, ,. ... '%°
447 ♦ e
(t�I.fit) ,. r` '8
O \\'
1t> 952r1 ,,,
Inn2.1 t-9 t.n9,t %, ,-R
2.Sc� I
115 t2 err Itl�i2-1'
in92-II-IO
4y.
30 m
p
t00fl., 1
NC
PIN. 6487600776000
Pamlico County, MAPID: 1092-14-8
CALACRES: 1.55281820483162
This web site is being provided for the benefit of the general ACRES' 1.53
public.The entire risk associated with the use of this site is on the ACCOUNT: 22414
end user.No representation is made that this web she will meet MAP: 6487
the specific requirements of any person or will operate error-free or
without interruption.All other conditions or warranties,expressed BLOCK: 60
or implied are disclaimed.In no event will the County or Atlas LOT: 7
Geographic Data,Inc.be liable for any loss of use,business OWNER NAME: PEDERSEN LYNNE B
interruption,loss of profits,loss of data or
incidental/consequential damages arising from the use of this web OWNER_NAME2:
site.The County and Atlas Geographic Data,Inc.make no OWNER_ADDR: 7017 FAIRWINDS DRIVE
warranties or representations as to the accuracy of information an OWNER_CITY: ORIENTAL
this web site,nor do they assume any liability or responsibility for
any errors or omissions in its content.It is the sole responsibility of OWNER_STATE: NC
the end user to evaluate the accuracy,completeness,or OWNER_ZIP: 28571
usefulness of any information,opinion,advice,or other content SITUS_ADDR: 7017 FAIRWINDS DR
available through this web site. DEED_ACRES: 1.5
DEED_YR:
t Alt l.f[r� DEEDBOOK. 000407
r �� 1, .. DEEDPAGE: 38
7.1... SALEDATE: 8725/2003
��-' T SAL.E_AMT: 0
441'iii' t O tt;`! LEGAL_DESC: LOT 8 FAIRWINDS SUB
v- BLDG_VAL 392369
Pamlico County,NC LAND_VAL: 115500
202 Main Street TOTAL_VAL. 507869
Bayboro,NC 28515 CALC_ACRES: 1.6

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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3. A Signature
■ Print your name and address on the reverse X `
aAgent
so that we can return theAterd to you. " , ; 0 Addresse
■ Attach this card to the back of the maiiplece, B.,Received by(Printed Name) 0. Date of Deliver
or on the front If space permits. ..)-t
r
1. Mole Addressed to:, D.Is delivery address different from item 1? ❑Yes
1✓♦ ,, ;117 It YES,enter delivery address below: No
3. Service Type 0 Priority Mad Express®
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII o pR Rem
Certified
9590 9402 2653 6336 0921 68 0 Certified Mad Restricted Denve r O Return Receipt for
❑Collect on Delvery Merchandise
2. Article Number(Transfer from service label) 0 Collect on Delivery Restricted Delivery 0 Signature ConlvmatIonr
tall O Signature Confirmation
7 018 0040 0001 0846 5769 fall Restricted Delivery Restricted WNW
ii PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
1
SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3. A.Signature
CI Agent
■ Print your name and address on the reverse X d L'L� edioK ❑Addresser
so that we can return the card to you. B.Received by(Printed Name) .Date of Deliver
■ Attach this card to the back of the mailpiece,
or on the front if space permits. ;Wt./%''j e.-(J il?iL[e �J cry /l` 7
1. Article Addressed to: D.Is delivery address different trofn item 1? CI Yes
i1 if YES,enter delivery address below: ❑No
9ie.,V e‘A CNI(Vey
1107 Pi\)c ry fR- .
t-Ny e, e'i \1 c. , NIA., acA.-31)
II I IIIII ill III I II I IIIII I III I II I I I I I I1I 3. Service Type CIRgiity dA Express®
O Adult Signature ❑Registered Mara
El Adult Signature Restricted Delivery 0 Reglstered Mail Restrict
0 Certified Mai® De��erY
9590 9402 2653 6336 0921 75 ❑Certified Mad Restricted Delivery i7 Return Receipt for
0 Collect on Delivery 0 Signature Merchandise
2. Article Number(Transfer from service label) 0 Collect on Delivery Restricted Delivery0 Signature Confirmation
7 018 00 40 0 0 01 0 8 46 57 52 li Restricted Deliver„ Restricted Deliver'
Domestic Return Receip"
PS Form 3811,July 2015 PSN 7530-02-000-9053

hrst-C
t�1 USPS lss Mail
Postagee&Fees Paid
111111 f �I 11114111
11111 Permit No.G10
9590 9402 R5P6336 0921 68
United States •Sender:Please print your name,address,and ZIP+4®in this box•
Postal Service (b X i\A \ \A c
po Box 1 V)
tv\k/A\ JC,
USPS TRACK 4G#
First-Class Mail
Postage&Fees Paid
LISPS
Permit No.G-10
9590 9402 2653 6336 0921 75
United States •Sender:Please print your name,address,and ZIPW in this box•
Postal Service
.l_ `5 8k 1\ AV \N C.
?36X \
Ot\ eV\\ os,\\ \ L)
11111' i1111I1iti1l'IiJlt:lPlitid„14"11101h1g411

Applicant: ,_- ,^,11/0,A,
Date: 7 'J 2015
General Permit#: 7LI/0"1 ,3
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
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
"atitz, 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 impacts) impact amount) temp impacts) amount)
sl-k EL("R Dredge❑ Fil(�-Both ❑ Other. _Co('F% �d4i
V 2—
NI G 14 G goy( Dredge❑ Fill❑ Both ❑ Other Y—' S 00()E/
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both El Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill 0 Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑