Roberson, Marcellus

C? AMA / ❑ DREDGE & FILL No. 75985
A B C D
G,�!ENERAL PERMIT Previous permit#
J� dew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As V)tfforized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resource Commission ! an area environmental concern pursuant to 15A NCAC
/ ! % t j
0 R61es attached.
Applicant Name ! �'C�' �/ � C���°') Project Location: County
Phone # (11'�) 1 1
Authorized Agent
Affected ❑CW
AEC(s): [-'OEA
❑ PWS
StateiV"" ZIP��%
�l _
Ew Ll PTA
❑HHF ❑IH
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s) .
Floating Platform(s) _
Finger pier(s)
Groin length
number
Bulkhead/ Ripmp lent
avg distance off!
max distance of
Basin, channel
Boat ramp
Boathouse/
Beach Bulldozing
Other
Shoreline Length
SAV: not sureJyesno
Moratorium: n/a
Photos:
Waiver Attached: yes (no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
or Applicant Printed Name
❑ ES ❑ PTS
❑ UBA ❑ N/A
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIPS
Phone# O River Basin �/ r
t
Adj. Wtr. Body ( ' / "" r (oat Iman unkn
Closest Maj. Wtr. Body / < ' J'
G(-'14 rl ")
1i n
(Scale:
❑ See note on back regarding River Basin rules.
r
**ase read compliance statement on back of permit* Signature,
y Z r
Application Fee(s) Check# IssuingD to r txpira4ion 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 El 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 complywith 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, INC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.orgtweb/cm/dcm-home
Revised 7/06/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting' Permit: /� lacee lluS �1�rs�+r�
Mailing Address: I4n9 H l cdx-)r� �JOvIlt/O�
lip1c ?- ei� 1
Phone Number: 9 lot ho- 2 -7-, 01010
Email Address: u0b 35 e +reJ 1, rrN
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: +o c-e lal ICE
J J
at my property l- located at I I lS
in C'9'A6CCA County.
I furthermore certify that 1 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:
1/nSignature
(hx,-6-e/fht, VLo���S�n
Print or Type Name
Date
This certification is valid through

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to act e��us R,-3 cs n —'s
property located at
/i tAOOress, LOT, I31OCK, K
on CM+J y,fj , iS 0t^s �� N.C.
(Waterbody) (Clty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc t
�
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)
LI 13
Z5
ffl13'
L� l L� I LA
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.
Owner Information)
111111512dim
r) -rk-15
Dare
i Urryisrareitrp
•&V✓
Tel hone Number/email addre s
2 0o
Dare*
'Valid for one calendar year after signature'
in)
(Revised Aug. 2U,41

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to r losteA\us Mihess n Is
1 Name of Propperty Owner)
property located atg j � C., n od,, t o a
/� f /n� ^ 1 1 (Address, Lot, Block, R d, etc.)
on t tr ct LG� Uan, l in F = poi ���� � �s �=: N.C.
(Waterbody) (Citylrown 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 DEVELOPMENT
(individual proposing development must Bll in description below or attach a site drawing)
LI 13
w",
LOA
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.
1 do not wish to waive the 15' setback requirement
(Property Owner Information)
ld —ry—i9 Girr,
Date
(Adjacent Property
)Owner Information)
04 i9n+t, Of*5'S�' e
Signature* _ T &uunwF hF
i:i M&W6,ss Jk—
(Revised Aug. 2014)
'Valid for one calendar year after signature'

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