Bellono, Greg

CAMA / ❑ DREDGE & FILL
NO. 75991
®El
GENERAL PERMIT
A B C
Previous permit#
D
❑New ❑Modification ❑Complete Reissue
❑Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
/ / / I ,, (-
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
I '
Rules a ached.
Applicant Name ; i
Project Location:
County
Address V i �: "",
Street Address/ State Road/ Lot #(s)
City ' fl '1 ` State d ZIP
Phone # O��� /��' �' E-Mail
Subdivision
Authorized Agent
City `
I _ \ ZIP
❑CW ❑EW [I PTA OES ❑PTS
Phone#O
River BasinAffected
AEC(s): �OEA ❑HHF ❑IH ❑UBA ❑N/A
Adj. Wtr. Body____L(nat/man=/unkn)
❑ PWS:
ORW: yes / no PNA yes / no
Closest Maj. Wtr.
Body
Type of Project/ Activity
.■.......�C�
.........■■. ■MINI■.
■■■■■■■■■■■■■
■■■■■■M■■■■EMrffinow ■
SOMMEMMEMEMEME
'■'■'■'■'■'■'■'■:'■MENIM.'.'■!'■n:.'■'.E
C'■'■'■'■'■EMNON■'.
■■■■■■■■■■M■■■■NNNIM■■MI■I�II■O■M■M■■■M■N
.............
...■.....■■■■■■■■■
■o■■....■■■.
■■■■■■�■■■■■■■■■■II■■
'■:I'■'■C'■'.'■'.::'■
MOMM :'■'■'■E '.'■'■'.'.�.:'■C'■'■'■:
M■■■M ■■■■■■■■■
■■■■■■■■■■ ...■■ ....
■■M®I®®
.■■■■E� ■.® �N■I:
I...IMN...■
■■M■M■M■MM■M■M■
■.■■.■..■■■■EC■■■■■M■■■
NM
OMN
ESE
NM
MEMNON 11::::::NNIMEMEN
IMES 0 0 IMMEM
••'■ M:'■'■1C'.'■'■:'■'■
MC '"MEMEMEM
C®01, ::
ME
Agent or Applicant Printed Name Permit Officer's Printed Name i
Sign t re ** Please read compliance statementon back of permit** Signatu e
ffy«, '%;'�>
Application Fee(s) Check# Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: IS-0-7 ClAq/UV i L C(: :5(9,
Phone Number:
Email Address:
i�y0i� �-qqZo
6-(5eL�Lo ti3OQ GM/a-tL, C o Nt
I certify that I have authorized DENNIS & SONS MARINE CONST. LLC
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Balc f< lkc' 'r,
at my property located at TS61 6Xx cS EY L-A�-D
in CARTERET
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:
Signature
Print or Type Name
c i/je-
Title
Date
g116 bi->
This certification is valid through-

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: j ec� �Jc 1 Ylb
Address of Property: C 1 CAY� --'r
(Lot or Street #, Street o Road, City & County)
Agent's Name #: WILLIAM DENNIS Mailing Address: 109 SEAHORSE DRIVE
Agent's phone #: [phone] BEAUFORT, NC 28516
I hereby certify that I own property adjacent 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.
�11zl 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. Contact information for DCM offices is
availableathttp://www.nccoastalmanagement.net/web/cm/staff-listing orbycalling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Property Owner Information)
Signature
Print or TypJ Name
I so'7 C, cutiv (1e x;-
Mailing Address
1-c rzi Ms4erS i 1= L 339 19
City/state/Zip
—%a(-4 re>CIL4--
Telephone Number/Email Address
(Riparian Property Owner Information)
n ,
Signatu e
Print or Type Name
assYa-'/�J�
e'-1 Ln P.
Mailing Address
)s,�,4cr tor'�I
City/state2ip
Telephone Number/Email Address
/ /'7/�O-D
Date
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: G-2CG, -;�>EL-L-C>t--DCD
Address of Property: Qv->61 6 r�,, S G`f L-A 1-1 6 6G v4-F< La /C�a x._rk �
(Lot or Street #, Street or Road, City & County)
Agent's Name #: WILLIAM DENNIS Mailing Address: 109 SEAHORSE DRIVE
Agent's phone #: [phone] BEAUFORT, NC 28516
I hereby certify that I own property adjacent 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. Contact information for DCM offices is
available athttp•//www nccoastairnanagement netlweb/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
1 of'V NLYLk
City/State2ip
L� q lb) ` LI Gi g l.O
Telephone Number/Email Address
(Riparin P o erty Own r Information)
Signature
W I I ( I /I IV, �L 1/'r/ Al
Print or Type Name
i Ict �,),)�(YIiC OL 11wC
Mailing Address r
IJ U `'I 0 1 u f\i
City/State2ip
Telephone Number/Email Address
-)--Ilzd)�o
Date
Date
(Revised Aug. 2014)