75425_Dale Tilson_20200128

0 7. CAMA / DREDGE & FILL '' 17 4 to 5 05a No. 75425
GENERAL_ PERMIT ��KS Previous permit# A g` , CD'
)� New '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 Commission in an area of environmental concern pursuant to I 5A NCAC 1 A-/ • / 2 ' --- -
[ 'Rules attached.
Applicant Name P.sz_E -T/z..SoA./ Project Location: County:- 21 /'c.) ,
Address 3/et 2Li ,--► C i'�e k LA) . Street Address/State Road/Lot#(s) 6 p-P 512 I 3
City FvZ,i4tl2P StatesG ZIP -z-) * z.. / i 31 =i 1") iL 3-I n ,,, l=-tt-v.
Phone# (zcz)sz-z.- Cie E-Mail Subdivision
Authorized Agent i jBC Ag2i y r t City -cam 4.v00--0 - ZIP 2-7 2 J
Affected kCW ❑EW $PTA ❑ES ❑PTS Phone# ( ) River Basin-1 Z-PL1-1 i co
(s : Adj.=OEA HHF ❑IH ❑UBA -WA
AEC Wtr. Body 172a c1 A^n ( r2--eti nat Oman /unkn)
PWS: 'PaM! ,/U L V
\' PNA yes / no
Closest Maj.Wtr. Body to
ORW: yes / no
I
Type of Project/Activity 90 r 'Pi bi, , 3J x' /0 P//1-i)4—/ 3v r /o S-r- 0O w "",.l
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(Scale:) _ J ' )
Pier(dock)length •j 'Y (o ' -
Fixed Platform(s)3Z) 'K f6 ' ' _ - I .�-� s '
I
Floating Platform(s) I _?/)vP •
Finger pier(s)3) Y i O ' ! 4 :
Groin length ! . -. 0 $ l
number 9�g n tAl - .
I e.
Bulkhead/Riprap length i �Y
avg distance offshore \
max distance offshore 4
Basin,channel I O I O
I
cubic yardsi .. ,
,_
o
Boat ramI . a'
Boathouse/Boatlift f QfES•� Ia.� C -1,...
Beach Bulldozing --i-\---
Other ` i 4,'
\ , :
- 1.- 5)4 Pa'', ' ,
Shoreline Length —+G 0 CJ
SAV: not sure) yes no _ __ —II— .-/
i I _ - ! 4—
Moratorium: n/a yes no ,
Photos: yes )
Waiver Attached: yes no ,. Do 1- 2 ivl'W • - I _ -.-
A building permit may be required by: .13E f001 r- iv, . 4 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions A,p L.,-/4-7-i ?'Lve'-'s - a v O r ',/1'i'r—z>T1"^. �1 L M " 5•c—
• .-- )ti —2)La f\<'St]0 c- ‘.0 1E11./i-t-,n -'ji, -,-1 2J"c , -
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? CA„ L41:7 L 1 -3 p)1.4_,--)
Agent or, pli t Pri d e PermitOircer's Printed Name
r /'y
Signs a (1*Please read ompliance statement on back of permit** Signs
pXLti . $ --)__Y--.) 3 L)-4A1( — A--,...) 7----, =.S ,---.A 2 -' -
Application Fee(s) Check# 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 I)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 I I 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- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: D/ )^ 1 11-5 OAi/
Mailing Address: -3ji It) V' RHA}-M CRC Llv
t-i)w4,0 i ►�� 21�a-1
Phone Number: 5 - -33.)— I O..
Email Address: D►TI LOIN® U i XXf3.E b(0
I certify that I have authorized D OB CA-K.12\1LE
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 3 1 R A v R N A P1 C i EE fK C Iv j .b w4 R b, fvG ,
in b Ef It F 0 KT' County.
I furthermore certify that I 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:
61‘ P.L `T
Signature
D oM
Print or Type Name
OWM
Title
ID- I Ia- oi9
Date
This certification is valid through I I

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ),4`E j 1 15 o t✓ 's
located at 3 (Name of Property Owner)
property D Li i HAM G fi 14, L lv
on �} V R }�,4 (Address, Lot, Block, Road, etc.)
n'1 G R' E_ EK , in b IM,9-ft i 1 13 R oRT c-G i , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
•
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Ytt 's ,
Q�� 11 (5 "
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WAIVER SECTION
I understand that a pier, dobk, 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.)
CZe I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) Ad acen Property
� ! p rty wner Information)
Signature -
*
D LE 17i-5o 1\1 s�gna6; I E f 7rit-laic,!
Print or Type Name Print or Type Name
31q pv[V-1/+M L (V /70/
Mailing Address Main ddress
b i N a70.) kj,1-5 /IvG, 773 Afc_City/State/Zip City/State/Zip
-s -33a-1o55 N'1LS(7NOU1't✓kAS: .bV a� -� 3 _53c.5a
Telephone Number/email address
Telephone N rnb r email address
Date / /
Date*
`Valid for one calendar year after signature (Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1)4 1.—E 1-1 1-5 o 1\Y 'S
(Name of Property Owner
property located at .3 i ( D U i- HAM c fi t e IA L IV )
(Address, Lot, Block, Road, etc.)
on b UR HA-A/ GAFEX. , in E 'd w.t}-L?D1 13-A-UFoRT `o, , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatjon.
�( I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
1
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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.)
jig P I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
--Pc5 (PyloPNATE CovNWA7N, roc
- - Signature - Si ature*A, g.�T ) � �P cZ>�b - -
D A-LE T7 L-5o Iv Jo AN) ft, A sc..aTr
Print or Type Name
i i C1 D (t--4/v c / El K L. f/ Print or Type Name
Mailing Address
Q ' 3gx LOS
G �V"�R D N 7�'D ) Mailing Address
City/State/Zip City/State/Zip1
tg-s -3-)--I OS"3 D-,-'ILsovou-aloS; ou ash- 3a-'a-- sia,l
Telephone Number/email address
Telephone Number/email address
la- I> -aviq --bE n(6-cR j1 Date
Date*
*Valid for one calendar year after signature (Revised Aug. 2014)

I i
NC division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant P4 2...E
Date: -2_ � j 20 Zp
General Permit#: .7 r 9 Z
Describe below the HABITAT disturbances for the application. All values should match the name,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft FINAL Sq,Ft. TOTAL Feet FINAL Feet
(Applied for. (Anticipatedfinal (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Habitat Name Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or letup restoration or temp impact
temp impacts) impactamcuntL temp impacts) amount)
2 ]
STe*'L
Dredge❑ Fill❑ Both 0 Other 4/',/p 2 !tear
D P!l?�!
1A N Dredge❑ Fill❑ Both ❑ Other, ] 4e25, ecopf
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge El Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other El
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 El Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑ •
Dredge❑ Fill❑ Both ❑ Other ❑ •