71288A_Coker, Janice & David_20190723

111,
i1CAMIA / '1XDREDGE & FILL NO 71288 �� V
GENERAL PERMIT Previous permit# �A B C D
❑Mew —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 Co mission in an area of environmental concern pursuant to I SA NCAC
JAq4w0IIIIlIl ( tv i l 1),1 v I "i k1 Rules attached.
Applicant Name Project Location: County PCB chi i M "6 I
Address 2(00'7 '%� l�fC _ S��� Street Address/ State Road/ Lot #(s)
City �tIC�N State I C ZIP 21b° ,
Phone # ( ) /, - 4 - 26 b2. E-Mail
Authorized Agent ��/�
Affected ❑ CW ;t EW JFe(hTA 4ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / frsQ` PNA yes /
A'/dal
Subdivision S1/9,0t./1i
City litpi l FC, 0) ZIP Z
Phone # ( ) S£ River Basin (�/I•5��-3t��K
Adj. Wtr. Body CX1JA/ /1&djerhel1 Fnat ma /unkn)
Closest Maj. Wtr. Body�� w�
No
SOMME
MENIMME11,
"'MEN
1'111,5611
139MEMEN
ME
MNIMM
MEN
IMMEMOMME
No
M.
M. M.
twMEMMEMONEMEM
..ch Bulldozing
.SIR
;reline Length
not sure no
. .. ..
MW
..
wnw
�. mill•
L4
-
■■■r■■■//■■■■■�!��■■■■■■■
ill■■■■■®■■���■■■
Agent or plicant Printed Name
Signatur� Ple e r ad compliance statement on back of permit'*'"
�,- ,
Application Fe(s) Check #
,vQ �MTth r
Permit officer's Printed Name
Signature
J � z 1 - z 7, r
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:
Ll 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to .j1 J v� r C-6- .s
1 Name of Property Owner
property located at i & 1 6 -- � 152 - i 6 ; A
(Adilress, Lot, Block,. Road, etc.)
on 1 axle �.: , iny� I`) L- , N.C.
(Waterbody) (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 fill in description below or attach a site drawing)
(S�1-A '1 iSb- �� �- � Sou—�-d,
b
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.)
t�
(P
✓ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
%A --
Print or Type Name
1 'S YYIa"45 � t
M n? Address , 09
City/State p
-
Telep hoe umber/email address
f .���-.
Date
*Valid for one calendar year after signature*
(Adja ant P operty Owner Information)
Signature*
Print or Type Name
) Z C- IDA-/ Xi✓ v c L_
Mailing Address
City/state2ip
Telephone Number/ email address
17.�v, --v I.?
Date*
(Revised Aug. 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
'-��9":1--
Email Address:
I certify that I have authorized J 1 C
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 'B a--k kzfAl ye-pla`R''"' -`-
at my property located at 1: k
in 1 1—(-A- a-_r10tNS 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.
Property Owner Information:
Signature
Print or Type Name
Title
Date
This certification is valid through / I

Coker
124 Holiday Knoll
V
� k�� t J � 6 aR :•n �{
fYAT

NC Division of Coastal Nlgt. Habitat Impact Computer Sheet
Applicant: �%�4ti< « cv l'/tti 1 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
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tempimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
L 8I
S
Dredge ❑ Fill q Both ❑ Other ❑
Dredge ❑ Fill [I Both ❑ Other,.']
LjQ('
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 ❑
7rraa. a= a=alMa-n

E ..
� �/\?