75676A_Katz, Frank & Pamela_20191118

LAMA / ❑ DREDGE & FILL CANo. 75676 B C D
GENERAL PERMIT Previous permit#
4New ❑Modification ❑Complete Reissue El 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 79
,121 Rules attached.
Applicant Name a„ k!j-- 6/, c /Q K a l Z
Address .Z_9 3 Y e �. 4 e S La n A
City 14,- (4-(:o State N -- ZIP
Phone # =) �20- 35T5 E-Mail
Authorized Agent 9,ibv
❑ CW
4EW
li PTA ❑ ES ❑ PTS
Affected
AEC(s):
❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW:
yes / no
PNA
yes /; no;
Project Location: County U M 4
Street Address/ State Road/ Lot
rk el
Subdivision —
City ZIP 2 y Y
Phone # ( ) River Basin
Adj. Wtr. Body ( V: ti r i nat man unkn
Closest Maj. Wtr. Body
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Agent or Applican� �e i
Signature Please read compliance statement on back of permit **
Application Fee(s) Check #
t Officer's Printed Name
natu
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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 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, INC 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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Dale `r
Nettie of Propern. (honer Applying for Permit:
Mailing Address:
I certih- that I have authorized (agent) !, .c ^�' f4 to art on my
behalf. for the purpose of applying for and obtaining all CANNA Permits accessary to
install or construct (activih) '_ LL LXT ,
at (my property located at) �i.�j _ L t f�; S L/V
This certification is valid thru (date) Liz f
Property Owner Signature
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property C)wn. e,-
Address` Prolery �J�� (�► 1S �N t��'�'�V , /'J� !��<QU}►rLl�%1L'S
(Lot o! Street *, Street or Road, City & County)
Agent's Name: ��Izwti } t 1 E_ Mailing Address . - -- — ----
Agent's phone 1#: S s 3
'T
I hereby cerhty that I owr property adjacent to the above referenced property. The individual
applying for this permit has described tc vie as shown or the attached drawing_the development
they ap pf oposing. A description or drawjnp,with dimensions, must be provided with this letter
1 have no objections to this proposal. 1 have objection, to th:. proposal.
If you nave objections to what is being proposed, you must not/fy the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be fnailed to 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contactod at [phone]. No
response is corisfdered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
i understand that a pier, deck mooring pilings, breakwater boathouse, lift, or grain must be set
back a minimum distance of 15 frorr my area of riparian access unless waived by me. (If you
wish to
wai ust the setback, you mini ial the appropriate blank below.)
L - I dG wish to waive. trip 1,5 setback requirem, ent.
do not wilt` to waive the 15' Setback requirement.
(Property Owner Information)
St�,'rlQilf rt'
r
Print or Type Name
41a�:�nq .40dress
'7s � - � T r11139�i
Tsfeph,are N9,mber
1 h�rr
(Adjacent P Owner Information)
Print or Type Name
Mailing Address
`�L? aiv N
r --
c- � 7 -1 � �City/stwe%�z1p
Tetephore Number
Dare
Revised 6,18,2012

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY
OWNER NOTIFICATION/WAIVER FORM
Narle of Property Owner
Address of Pro rt 3 1 7E i � N Hag 1tT c � �C
` � y� T
i i of or Street 4, S-ee? or Road, rtty & ",OUI'ty)
Agent's Name a-10"- _tii! E
y_-
Agent's tahone 3 3 7- y_--0, i _
4141vs
Mailing Address:
tr
ill �4� t rl
hereby certity tha' I own properly adjacent to the above referenced property The individual
applying for this permit has descemed to me as shown on the attached dra%viny the developmert
they are proposing. A description or drawing, with dimensions, must be provided with thi I er.
I ha%e :,o objections to this prt�posa;. ! havc c►bjcctiorts tc this proposal.
Of you have objections to what is beinq proposed, yc�si must notify the Division of Coastai Managernfrrt
(DCM) In writing within 10 days of receipt of this notice. Correspondence should be rnailfrd to 1367 tIS
17 South, Elizabeth City, NC, 2790.4 nC M rfpresentatives can also be contacted at (2521264-3901 No
response is considered the tiNmp as no objection it you have been notified by Cortifie4d Mart
WAIVER SECTION
i understand that a pier.. dock, mooring pilings, breakwater, baathouse. lift, or groin must be set
back a minimum distance of t 5' frorn my area of riparian access unless waived oy me. (It you
wish to waive the setback, VOL must initial the appropriate blank below.)
_.. -___. I do wish to waive the 15' setback requirement.
I do not wish :o wa,ve the 15' setback requirement.
(Proy Owner Information)
S: f�►tt �; tr rf
print of iyve Nttrne
q3 i }rEEs Lv'___._
lrtarling .Aridr935
City/Stareu2rp
Telephone Number
(Adjacent Property Owner Information)
roi,ErJA
Prim, or Type Narrie
AUAing Address
C.+411',1 �o�', �`� 116b ..
CityrStare, Zip
Teiepnone Number
Ci
Darr Durr
Revised 66 t&2012

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2019-11- 06 M 2019-11-06