78517A_Holloman, Bill_20200225

❑dAMA / ❑ DREDGE & FILL
-. GENERAL PERMIT
KNew Modification ❑Complete Reissue ElPartial Reissue
N9 78517
Previous permit #
Date previous permit issued_
As authorized by the State of North Carolina, Department of Environmental Quality r�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 714 2C(
® Rules attached.
Applicant Name E r I I 060 U m G. n
Address W ]I Y111, Tr I .
City Ed e n� n state�CV ,_ zIP o2 -7q 3 Z
Phone # ('759) 214 — 8199 E-Mail
Authorized Agent Trays" �- i i
Affected ❑ Cw 91 EW I% PTA ❑ ES ❑ PTS
AEC(s): ElOEA ElHHF ❑ IH ❑ UBA ElN/A
❑ PWS:
ORW: yes / :no PNA yes / no
Project Location: County_ 0 h OL,,)Q
Street Address/ State Road/ Lot #(s)_
B C D
Subdivision f3r4&N
City (�c4-:rJc5f\ ZIP q 3 Z
Phone # ( ) River Basin �' kc) wa Y\
Adj. Wtr. Body �, nL JQ N e4 V"E.'r- (nat Jm� n)
Closest Mal. Wtr. Body
Type of Project/ Activity �0�4 t I �ar�S+Yt,C 3 1 X i
Pier (dock) lei
Fixed Platforn
Floating Platfc
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg distz
max disc
Basin, channe
cubic ya
Boat ramp _
Boathouse/, 9
Beach Bulldo;
Other
Shoreline Len
SAV: n
Moratorium:
Photos:
Waiver Attacl
A building permit may be required by: f)'.AJQ iir� COL, A- L t ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agen or Applicant Pri ed Name F
i
Signature ** Please read compliance statement on back of permit*
Application Fee(s) Check #
C�A A : C' IZa r,+rlp-.k
PermitOffi rrs Printed Name
Signature
Z/;zs /ate/2s /ao
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 how to complywith 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 -
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

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: W' l j j a m f a ! ► o✓n n r�
Mailing address: Y VV I Aet6a c , L2
Telephone Number: `% 7 7 11
I certify that I have authorized 1"V, 5 rl�� (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of -13,q4 !! (4 4w&j
at my property located at ! N Pj �2 6
This certification is valid through ,e"A G���-'�� (date).
(Property Owner Infor ation)
Signature
�I-/1r441 4//1"4d
Print or Type Name
Iy,,///'I � A�i/ - 0s J
Title, co. owner or trustee for property
Date
T- 7- ?-76/- Vg�?
Telephone Number
Email Address

El

ADJACENT RIPARIAN PROPERTY OW ER STATEMENT
1 hereby certify that I own property adjacent to �� �`�-� 's
` I (Nam of Property Owner)
property located at Z10
(Address, Lo ,, $1 k, Road, etc.
s � , 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 till in description below or attach a site drawing)
u r�
.3'X 12
C; c�- y pt►es i 2 nr z
F Ov
H,V
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.)
li I do wish to waive the 15' setback requirement.
(Property
I do not wish to waive the 15' setback requirement.
kv
Print or Type Name
J/y 6V'-4tie6$5-6 -tic
Mailing A s,, // r
City/StatelZip
75 -7- -2-7 Tr y
Telephone Number/email address
/- DIY-0101.2v
Date
*Valid for one calendar year after signature*
(Adjace plPropeOwner Information)
Signature
Print or Type Name
f l C CrJ�.L •z-�� � j.2,
Mailing Ad ress
City/Stat&Dp
:2j-�7 /,;76 z
Telephone Numb¢er/e ail address
/ 12W/,1
Date *
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ice" F07-0 's
(Name of Property owner)
property located at
(Address, Lot, Block Road, etc.)
on v 'aj x)a in �� �� ��� _ Z`1�`J , N.C.
(WaterbodY) (CityRown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
—94--l_ 1 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 aiiach a site drawing)
'.D
� v
3x 12
C;cj- �pLle:h 12X1Z,
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.
(Froperty Owne formation)
Sij ture
a al
Print or Type Name
/ 1-4.11 "464I<-R 7-
ailing Add ss
City/State/Zip
Telephone Number/email address
-:z y -awd
Date
"Valid for one calendar year after signature`
(Adjacent Property Owner Information)
i reE
Print or Type Name
filing Address
City/StatelZi
714
L1'D- bz)\—
Telephone Number/email address
Date*
(Revised Aug. 2014)

so

r•.J µme, Y� ..
� 1 +'R � � kLl YA.�E Liy•
J Fi ' .d ♦ H
6 � iii+++iii
'�#y R �'�
��• AY
I
- tis My�+
Y �R
•
a
'
i
A
y
r
1

ZEbL7%