75679A_Coker, Janice & David_20191125

91!AMA / L1,13REDGE & FILL NO. 75679 B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification Complete Reissue ❑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 15A NCAC %
IEJ Rules attached.
Applicant Name Sa 6'� c 4 'I) J Co
Address), Cp % 5 i-. Inc, r r -z = —r—
city o �e', i �, State NC ZIP -Z 7-7
Phone # E-Mail c o iCe s d c to y G�►''. c „°'
Authorized Agent 4 c R , d' K
Affected ❑ CW PEW K PTA XS 'OPTS
AEC(s): Ll OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /` no-' PNA yes / nq
Project Location: County
Street Address/ State Road/ Lot #(s) �E,4S A 9 /57-A
/2 y ND/I a, `( o /r
Subdivision All; o. y a- 5 /G d
Cityf /e ZIP
Phone # (- ) _ River Basin �S + k
Adj. Wtr. Body �' c+ /� n ( a ^ ci nat man unkn
Closest Maj. Wtr. Body
in length
-head iprap length
max distance offshore
cubic yards
ramp
house/ Boatlift
reline Length
-
not sure . yes no 01,MFA
WFM
-tos: yes no
iver Attached:
-
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Agent or Applicant Printed Na e.
Signa re' "Please r ad compliance statement on back of permit"
Application Fee(s) Check #
Per it Officer's Printed Name
Sig ure
// /-2_S/,/ 7
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/ 1-888-4RCOAST 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

DREDGE & FILL NQ 71288
GENERAL PERMIT Previous permit# A B C D
C�F�lew 'Modification C-'Complete Reissue L :;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
,JAQ IC.C_ 'i t, i' J 0, f U ! %) I?1 Rules attached.
Applicant Name C. A�E..v� __ _ Project Location: County FL-y2 c :_; I' l r I � i `-
Address -;-- fap- 7 <F M A H v r-,'j� - E. i Street Address/ State Road/ Lot #(s)
Ci'State WC ZIP Z?bC' ___-- _ l t y lr,U�J:r✓i� /�iy�
Phone # E-Mail
Authorized'Agent
Affected ❑ CW A EW PTA 4ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / tq PNA yes / no
Subdivision {/►�►4/ ��Yltllii
City lit 41 j f Ci ti) ZIP ._Z_ l
Phone # ( ) ';£` River Basin
Adj. Wtr. Body. CX1JX L ii'��">r�l1r � � riat ma /unkn)
Closest Maj. Wtr. Body __ &-/A-,Y)
MEN
ME
M
MEN
MMOME
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or
compliance statement on back of permit **
ApplicationFeb(s) I Check#
L4ivi,i 1�4-ETtti r
Permit Officer's Printed Name
�
Signature_ -'
Issuing Date Expiration Date`

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to b vk I, C b �� �� s
i Name of Property Owner
property located at
(Address, Lot, Block, Road, etc.)
,/�
on i"1"� YYl�r�e �ot� M�- in "e'44w-'A I)C- N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMtN I
(Individual proposing development must fill in description below or attach a site drawing)
•�j�-�.eucg
i ,1 A ks�-A
��- �•� �r low LZA
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.
on)
Print or Type Name f.
Maiiinq Address q
City/State p
Telephone Number/email address
Date
*Valid for one calendar year after signature*
(Adjacent RropertY Owner Information)
Signature*
ii:-- D L V-
Print or Type Name
) � ^ I_),0i 9A %
Mailing Address
I � V 2-7
City/State2ip
Telephone Number/ email address
){%v z u 1'7 -
Date* '
(Revised Aug. 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: y�Cl�l
Mailing Address: a�ori `S� fy)J-' 5 �
-�AC-�
Phone Number: `�� kN `a)'
Email Address:
I certify that I have authorized -3 a
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1811-LK-
at my property located at
in County.
/ furthermore certify that / 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.
Pro erty Owner Information:
Signature
r �
Print or Type Name
Title
Date
This certification is valid through I I

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~ 2019-10-21