Madden, Carol

0
OCAMA / ❑ DREDGE & FILL NO 70909
A B C D
N
GENERAL PERMIT Previous permit#
Lf7New ❑MQdification ❑Complete Reissue ❑Partial Reiissue 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
El Rules attached.
Applicant {lame Project Location: County `ac'"`
City ' (, State ZIP, ;
Phone # ( r E-Mail
Authorized Agent
Affected .P tWW {ETA ❑ ES ❑ PTS
AEC(s): LJ OEA ❑ HHF H ❑ UBA ❑ N/A
n cws.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of ermit**
.. 4�Boa.
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s)
r
f—
Subdivis' n_
ZIP
Phone # ( ) /' River Basin
Adj. Wtr. Body_. (nat /man /unkn)

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, certifythatthis project is consistentwith 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/1-888ARCOAST
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

o
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date 0/7
Applicant Name Lc.X r
Cr
John E. Skvarla, III
Secretary
RECE1W
JAN 2 2 201g
Mailing Address I-,9/a e--`L re-,4 <,--+ DCfVl-
AAHD CITY
/iFiv r-; �t> V''//
I certify that I have authorized (agent) i:�--r * c C-11& to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
)Pac
,%4—'D r— -/—
This certification is valid thru (date)
Signature
400 Commerce Ave., Morehead City, NC 28557
Phone:[phone] \ FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer
at (location)
NorthCarolina
Nd&i r&

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to _
property located at r F
(Address, Lot,
on ka r-�� /f��` i in
(Water ody)
7 Al(-fFA/ 's
operty Owner)
c.)
r f'- , N.C.
and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location/
QTj I have no objection to this proposal.
TL-
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
t/,-X7-!r
v V+
a {
I I r 5tareJ7r
/' qJ d - t/
-rra^$Dr CEpltef
f r&f E�'�fit
WAIVER SECTION I JAN
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groigi AJ&&e set
back a minimum distance of 15' from my area of riparian access unle i iyed by me. (If you
wish to waive the setback, you must initial the appropriate blank below. 6��tVVdl j� (;jl.rY
I do wish to waive the 15' setback requirement.
not wish to waive the 15' setback requirement.
(Property Owner Information)
Date
(Adjacent Property Owner Inform Lion)
<e / , L/C's �cL
Si note �o
� l f "'t, (�
Print or Tye JVame
�'�JC�' 41C_
b M/J
(Revised 611812012)

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CORNELIUS, NC 28031
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[CAMA / ❑ DREDGE & FILL NO 70909 .
A B (C D
!!!!llR ENEAL PERMIT Previous permit#
New ,❑Modification ❑Complete Reissue ❑Partial Resissue -A Date previous permit issued
As author
ized by the State of North Carolina, Department of Environmental Quality J{ �//,1
and the Coastal Rerurces Com ission i an area ofienvironmental concern pursuant to I SA NCAC
1U/'ILL,
t j t ❑Rules attac led.
(la Applicant me 1 .t U�- i clt ,i,' f� Project Location:, County
Phone # t
Authorized Agent i A
`®
'9TA -
Affected]
CW E�W
❑ ES ❑ P75
N/A
AEC(s):
OEA HF
IH
❑ UBA ❑
❑ MS:,
ORW:
yes / PNA
yes / mo
Street ddress/ State -Road/ Lot #(s) ,•
r
City 6'ri(,(.t
Phone # 0
Adj. Wtr. Body —
Closest Maj. Wtr.
River
ZIP
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Application Fee(s)