78501A_Scarborough, Jole_20200116

[ CAMA / ❑ DREDGE & FILL
�. GENERAL PERMIT
XNew ❑Modification ❑Complete Reissue ❑Partial Reissue
N9 78501
U B C D
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality _1� 200
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 X.�
ER Rules attached.
Applicant Name JU�e,
._f LaCbO ro VG1n
Address 2
CCGNU �,1 t"N Z
City MON+ Co
State zip-2-�-`154
Phone # Q"I ) SSD
I�Iolo(o2E-Mail
Authorized Agent
oi:26u eAS -,oc q
❑ Cw
%EW CPTA XES i <PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UIBA ❑ N/A
❑ PWS:
ORW: yes / no)
PNA yes / 60
Project Location: County a, k{Q,
Street Address/ State Road/ Lot #(s)
"'J Q.
Subdivision-C'g- ± 1A(- rq F_,�jrA,, s S 61K
City n>I+W _ ZIP 2-41 S q
Phone # ( ) River Basin vG40",C
Adj. Wtr. Body ti SOUr'ld ' (nab/man /unkn)
Closest Maj. Wtr. Body _A �X 1A"' e_
Type of Project/ Activity Co" SA f v L+ -2 9!0 I !a, G 'r , Z —1 � � � Dal AT'f o (M � 1Y � �` ofv CA
.4 "1 Sower OICA-(MS 0-4CA Z mr,oc%r►� 42 it5 (Scaler )
Pier (dock) length
Fixed Platform(s) 2hA (P .
i
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
T�
Basin, channel ---�
cubic yards
Boat ramp
Boathouse/ Boatlift -�
Beach Bulldozing
Other r
hl� L
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes
Photos: yes no
Waiver Attached: yes nv7
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions _I -)
Vw f, ❑ See note on back regarding River Basin rules.
Agent or Ap Printed Nam
x
Signature Please Ffffdcomp iance statement on back of permit
Application Fee(s) Check #
vc,ia �OP)85
PermitOfficdr' ,R ' Name
Signa
V1 /llo/2020 1Z5/lbi��2s�
Issuinj Date I Expiration ate

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, NC 28557 Washington, NC 27889
252-808-2808/ I-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

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: -Yu Le- (0 roy
Mailing address:
Telephone Number:
I I Z Cct)
/YV+-ckj L�Lo 4 ZY C-, 2-'2 z
I certify that I have authorized !ALL k2c— (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 1 u-�? ,/ Cjc--_
at my property located at V [ Z
:/1.
a7�J�
This certification is valid through (date).
(Property Owner Information)
Signature
Print or Type Name
Title, co. owner or trustee for property
Date
g � s--- (c j -- C- (C- (0 z---,
Telephone Number
Email Address

Wol TANA 11,14. 3qii4Cl-iM,%-7v:)Ivo f 94' '4301
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property: \ vZ
(Lot or Street #, Street orr Road, City & County)
Agent's Name Mailing Address:
1 l 0r -2,J T-c-a�--
Agent's phone #: b�Z _ � Q 7 —
I Z D I N - 14 w..� la 4-I Zle,47 /VIP 0 VG^fl I /V, L Zq 9-5-�
1 hereby certify that I own property ad'a� cent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
_ 1 have no objections to this proposal. I have objections to this
proposal.
If you have objections to what Is being proposed, you must notify the Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
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 sign the appropriate blank below.)
Property Owner Informati )
Sig ature
ht or Type Name
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adj "nt Property Owner Information)
Signature*
Print or Tvoe Name
t t Z C f,,\N cam, Z�4 L, c--,.-� `a vo & t2o
Mailing Address Mailing Address

City/State/Zip
City/State/Zip
5,i S- 7(: I - C 61 �
Telephone Number/ Email Address
IZ�(
Date I
Zs2--;? o7 g235
Telephone Number/ Email Address
Date*
"Valid for one calendar year after signature' Revised 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: cKU (c� 5 Cs'- - 6 &-f- C) v �
Address of Property: _L2D�
(Lot or Street #, Street or Road, City & County)
Agent's Name #: a& E: 1� Mailing Address:
Agent's phone #: Z J Z � 6-5 — %,`��J k
1 hereby certify that I own property adt� 'ate to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
-� -`- I have no objections to this proposal. !have objections to this
proposal.
N you have objections to what is being proposed, you must notify the Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
noted by CertiNed Mail.
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 sign the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informs ' n) (Adjacent Property Owner Information)
z4x -V/SC -S /
S4hature Signature*
Prin r Type Name Print or Type Name
Mailing Address Mailing Address
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City/State/Zip
City/State/Zip
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Telephone Number/Email Address
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Date
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Telephone Number / Email Address
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Date*
*Valid for one calendar year after signature* Revised 2017

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This map is prepared
from data used for the 112 Canopy LN Owners: Scarborough, Jule Dee - Tax District: Manteo Out
inventory of the real Manteo NC, 27954 Primary Owner Subdivision: C R & Henry Evans Sub Blk B
property for tax Parcel: 016198000 Lot BLK-Sec: Lot: 1r Blk: B Sec:
`� • �� purposes. Primary
information sources such Pin: 987120917016 Building Value: $1,057,900 Property Use: Residential 11
as recorded deeds, plats, Land Value: $256,100 Building Type: Contemporary/modern 11%� ����
wills, and other primary Misc Value: $0 Year Built: 2012
public records should be
consulted for verification Total Value: $1,314,000
of the information

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THIS DOCUMENT ORIGINALLY ISSUED AND SEALED BY MANSON
RAYMEERINSL-2592. ON 01/OE/13. THIS MEDIA SMALLNOT
BE CONSIDERED A CERTIFIED DOCUMENT
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CONSTRUCTION
ENGINEERING
SERVICES, INC.
P.O. Box 665, Manteo, NC 27954
[phone]
FAX [phone]
JOB A�JmAk'l Pi n- ba CAI'�Mwv Lpt"g-
SHEET NO, OF
CALCULATED BY H. DATE
CHECKED BY DATE. —
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