Bares, Richard

®CAMA / ❑ DREDGE & FILL W 78964 A B h D
GENERAL PERMIT Previous permit#
PINew ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ,,�y n
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC OIL -, r l C
R I h d
Applicant Name t (1)a6'P' !lac"
Address � �"C((�I1`in� "t l /c
City I 1'1VE l r k? State ZIP S
Phone # (grl) // E-Mail
Authorized Agent C C V t t> ✓ E'
Affected AM NEW .AIPTA --iNj ES ❑PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no, PNA yes no
Project Location: County (,/! ; 1
Street Address/ State Road/ Lot #(s)
Subdivision
City t/. � � y r ZIP
Phone # ( ) ` River
�Basin
Adj. Wtr. Body I ! (( ` Gnat /man /unkn)
Closest Mal. Wtr. Body / f(>C'f�'� I :
'J■■■■■■■■�`d■
■■►1i
■m,■■■■■■■11�.
r
■■It1li ■■■■■■■■■►b■■■■■IA
ENE
■■
►�.� ■1►11/I■■■■■■�
No
ENE
Y �
■■ ■■■■■■■
■■■
.■C■■■.��Yf�ll�VFN
■■■ �rr ■
■ ru■
'�I�■►�iE�■■■■�
■■ ■■rI
no
!ttr/
If ►11f1
■ ■w[ME
■■■■
■WA ■■
MEE a
OEM
r
No MEMO
■ ■
■■■■■
■■■� n■■r�■■r■■■■
'INI/■■■ri■•■■■
�■l�■9! ,. wrn,■
e■■■w1110MM
■a`
sue Ill■■rl�■■■■►�
■iill■■ ■11110
�' ■1�0M
�IS}19■ME
WE
a
a
■ydiliffil
■■r■■
■■ /:w
%�
LIIR1■■
�0MM
■�/�THUi iri� Irk"
�lil■ait[yl
■�■■NoAv
I■■ r5
M U��1 's19
'■■
►nr�
■■■ J
■ no
■
�i■1.
■■■■7t1►J
CI�1■
Nam,
■ ■■■
.
` ■■■■�■■G��■■■/�1
■Iwl�rim
r
Il■1
■■■■■■
■■■■■
•■■■■w■1"it■■■■wV=I■■■■■■■■■■■■■■■■ON
ON
mo�ll
MEN �■1o�AI■i®■
ME
0��r�0■■
■■■■■■■wi�■I■uIN■■■
■�■■1�����
1�
MEN �■■M■■.■■
.■MEMO
l=ii
■�M:
1i ii■■E■
ENE
iii■■■EE�E■
�EM■ ■
NEE I■■■■■■■
■■■�EC�■
PermitOfficer's
Sig amre/+yy*'Please reaZ11c&m Rance statement on back of permit"
Application Feels) Check #

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: Richard Bares
Mailing address: #10 tr5Ns R- foOA� k`{
Telephone Number:
Havelock, NC 28532
[phone]
Riverfront Builders, LLC (dba Riverfront Docks) I certify that I have authorized (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of installation of concrete dock with platform
at my property located at 470 Fisher Town Road Havelock, NC 28532
This certification is valid through May 31, 2020 (date).
(Property Owner Information)
Signature
Richard Bares
Print or Type Name
Owner
Title, co. owner or trustee for property
Date
[phone]
Telephone Number
[e-mail]
Email Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Richard Bares 's
(Name of Property Owner)
property located at 470 Fisher Town Road, Lot 8 in Clubfoot Creek
(Address, Lot, Block, Road, etc.)
on Clubfoot Creek in Havelock / Craven County N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
76 t toalk Udt/
?OIx/Q/ Plaf�At
ELLIS BARES FISHER
Property Property Property
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
(Property Owy* Information) (Adjacent Property Owner Information)
daitis / Riverfront Builders
Print o)/Type Name
3614 Fort Road
Mailing Address
New Bern, NC 28560
City/StatelZip
[phone]
Telephone Number
February 21, 2020
Date
Signature
Eula Mae Fisher
Print or Type Name
420 Fisher Town Road
Mailing Address
Havelock, NC 28532
City/State/Zip
Telephone Number
Date
(Revised 611812012)

■ Complete items 1, 2, and S.
s Print your name and address on the reverse
so that we can return the card to you.
a Attach this card to the back of the mallplece,:
or on the front if space permits.
1. Article Addressed to:
Calk male s��r
�26 175`tw 74A .1�cj
; AoC4 PJ& 2W32
IIIIIIIIIIIIIIIIIIIIIIIIIIIII1111111NII11111
9590 9402 5638 9308 9606 27
7018 2290 0002 2362
PS Form 3811, July 2015 PSN 7630 02.000-9053
❑ Agent
v ❑ Addressee
by (Pilo ameJ C. D to of Delivery
D. Is delivery address different from item i? ❑ Ye:
If YES, enter delivery address below: ❑ No
J. �ervlCe type
❑ Priority Mail Express©
❑Adult Signature
❑RegisteredMali-
n clult Signature Restricted Delivery
❑ Registered Mall Restricted
Certified Mail®
Delivery
Certified Mall Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
❑ Signature ConfinnationTM
❑ Signature Confirmation
3850 led Delivery
Restricted Delivery
■ Complete items 1, 2, and 3, an
■ Print your name and address an the reverse 9�
so that we can return the card to you.
*'Attach this card to the back of the mallpiece, R. R slued by
. or on the front if space permits.
1. Article Addressed to:
ve locC, t�G ZYS32
IIIIIIIIIIIIIIIillllllllllllllllllllllll llllll
9590 9402 5638 9308 9606 41
1011 2290 0002 2362
, July 2015
Domestic Return Receipt
11 Agent
Addre,
11P4lyemeJ
A 10. Oats of Dell
D. is delivery address different from item 1? . 0 ye;
If YES, enter delivery address below: ❑ No
a. Service type
❑ Adult Signature
❑ Priority Mail Express®
❑Registered Mail^•+
❑ Adult Signature Restricted Dellvery
❑Certified Mall®
❑ Registered Mall Restricts
Delivery
❑ Certified Mall Restricted Delivery
❑ Collect on Dellvary
❑ Return Receipt for
Merchandise
O Collect on Delivery Restricted Delivery ❑ Signature Congrmatiori
O Insured Mail ❑ Signature Conrematlon
3843 "• t Restricted Delivery
Restricted Delivery
Domestic Return Receipt
Scanned with CamScanner