78515A_Adams, Lorne_20200218

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K CAMA /_ DREDGE & FILL N9 78515 (�) B C D
GENERAL PERMIT Previous permit#
❑INew - Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �7 L+
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC f I I 1 / C(
© Rules attached.
Applicant Name L o t o E_ 1 C'j fQ A S S Project Location: County
Address ,� y y 5 In r o o C* C + P �y 1), . Street Address/ State Road/ Lot #(s) L i rJ/a
City r-�) R It ,rocs State H ZIP OTC
Phone # r°5(S E-Mail �� ��Subdivision Ica_ I nj ihc, 5�C re 3
Authorized Agent V , t' 90 ( �9 G LI 4 City 4(r -1 o r-J ZIP
Affected ❑ Cw ❑ EW fl PTA M ES IERPTS Phone # ( ) River Basin SY c • a lti r,
❑ OEA ❑ HHF ❑ IH ❑ URA El WA
AEC(s): Adj. Wtr. Body kc ir�, r (e SLu ((natman /unkn)
❑ PWS: i
ORW: yes / no PNA yes / no i. Closest Maj. Wtr. Body
Type of Project/ Activity r' N w I V 1Y �f J �� 1 c, r n
(Scale: ? )
Pier (dock) length
Fixed Platform(s) y 4I I .]—.vF. I _ q Q i!
Floating Platform(s)
Finger pier(s) —
Groin length
number
Bulkhead/ Riprap length �-I0
avg distance offshore 2
max distance offshore 2 '
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
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rom
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Agent or Applicant Printed N�2a�ma_�
Signature ee Please read compliance statement on back of permit"
Application Fee(s) Check #
(" - , , -�a re.�
PermhOffi r { Pri
Signature
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 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 howto 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/ 1-888ARCOAST 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

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor +fames H. Gregson, Director Dee Freeman, Secretary
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Date: �� ,� � �' ) U
Name of Property Owner Applying for Permit: i o O e' A b A m
Mailing address:
I certify that I have authorized
7L[q �� ��uAb cr��G�r b��vI
tAolLyLo
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of r L e �i � _ /'/" #ea 4�
at my property located at
&C )- V
This certification is valid through (date).
Property Owner's Signature
logdcj AbAM �-
Print or Type Name
2qd - �-61-0Z�
Telephone Number
1367 U.S.17 South, Elizabeth City, Nodh Carolina 27909
Phone: [phone] FAX: [phone] Internet_ Mm.nccoastalmanagemeni.net
An Equal Opportunity 1 Afrumalive Action Employer - 50% Recycled 110% Past Consumer Paper

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. J'i
Address of Pmpetty:
(Lot or Street #, Street or Roab, City & Cott
_ �Aaiiing Address: __-------.. ---
Agent's Name #�: ------ `_ �--
Agent's phone
erty. The individual
I hereby certiy that i own property adjacent to the above referenced prop
applying for This permit has described to one with dimensions must bes shown onthe ached rovided w rawing_ the th this le�r.11
they are proposing. A description or dri
_ % I have no objections to this Proposal. I have objections co this prWosal.
you tEave objections to What is being proposed, you rnust notify the Division of coastal Management
if
if you) in writing within 10 days of receipt of this notice- correspondence should be mailed to 1367 US
17 South, Elizabetiz City. NC, 27909. DCM representatives can also be contacted at [phone]. No
e%=Qnnnse is considered the same as no objection if vou have been notified by certified Mail.
WAIVF-R SECTION
understand that a pier, dock, mooring pilings, 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 rnu` the appropriate blank below.)
— - t do wish toXmve' gie 1.5'seVack requirement.
I do notwish to waive the 15' setback requirement -
(Property Owner information)
l-
S;otzratur,;
Print cr Type Name
.r �t
Mailing Address
�it;�/Statel�iA
.Telephone Number
(Ripari it Property (/ .r i rmation)
_ ignnaattu're
print or Type Name
�ec
eiling Address
O r� //ity; te/Zip �---------_ _
,7S`;2 S F Z _ y y 3 8 ..
Telephone Num r

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICA.TIONTWAIVER FORM
Name of Property Owner: / ,o JZ �' Lr AD l,' �
Z7�y
Address of Property: L w� eu A- 14 6P Q: & e l] t"�
(Lot or Street #, Street or Road, City & County)
Agent's Name # 7
Agent's phone #:
Mailing Address:
l hereby certify that l 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 descri tion or drawing, with dimensions, must be nrniAded with this letter.
I 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
MCM) in writing within 10 days of receipt of this notice. correspondence shouldbe .mailed to 1367 US
17 South, Elizabeth City, NC, 27909. QCM representatives can also be contacted at [phone]. No
response is considered the same as no ob"ection if you have been notified by CerVfied Mail
WAIVER SEC'l'IOlV
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by rare. (if you wish to
waive the setback, you must initial the appropriate blank below.)
I do wish to *give_ toe .1.5' Setback requirement.
I do notwish to waive the 15, setback requirement.
(Property Owner In€ormation)
j
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Signature
r�`� AbA .
Print or Type Name
Mailing Address
City/State2ip -f
Lt
Telephone Number
(Riparian Pr perty Owner Information)
Signature 'r
Print or Type Name
Mallrng Address
itylS�attslZip
Telephone Number
.Dare
Date

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