78523A_Roycroft, David & Deborah_20200310

0-
©CAMA / ❑ DREDGE & FILL
r. GENERAL PERMIT
SINew ❑Modification El Complete Reissue El Partial Reissue
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 15A NCAC
N9 78523
Previous permit #
Date previous permit issued
V
B C D
❑ Rules attached.
Applicant Name
_D ' V i d
�e r �, h
o. tT r �� _ Project Location: County
Address `q US
bx-, r c F
2c.-.LA �d
Street Address/ State Road/ Lot #(s) L,4 ;
City I zu
�1, < <�..�
State NC
ZIP 2� O `�B 5 Ua ni e S 13cu, 9rl
Phone # ( )
Ico - v
/ E-Mail c �c:�x%rc.i�
, r . cry v�=�:±:,Subdivision )C. nC e 5
Authorized Agent
Vol n[e Sear le
City t +, z<<%i } C�� _ ZIP 1'79109
❑ CW
ER EW
® PTA El ES
ElPTS Phone # ( ) River Basin
Affected
❑ OEA
AEC(s):
❑ HHF
❑ IH ❑ UBA
❑ N/A ?
Adj. Wtr. Body L.A4j �Ivt, S{nat)/man /unkn)
❑ PWS:
i� 16 iE S
ORW: yes / no
PNA
yes /
Closest Maj. Wtr. Body rrc. I nu nrJ
'grim
ONE
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H
MIN
0 ISO
ONEME
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"now"
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MUNENNE
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NMIMIEI
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
t r OO' 33 �'tio
Application Fee(s) Check #
Permit Offi 's Printed Name
Signat to
3f Io f ;O].o �►Io�;��
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
Neuse River Basin Buffer Rules
Other:
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/ 1-888-4RCOAST 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
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)
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 FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: \ 1 , P V� rG
Mailing Address:
Phone Number:
Email Address:
certify that I have authorized
-Z)Ct,C
n
Vance Searle
Agent / Contractor
0
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: pk''F �
at my property located at "A(
in County.
/ furthermore certify that 1 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:
Print or , _. _
Title
�l a & l aO'Zf?
Date
This certification is valid through C/T / 3 O / d O \

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: q D.5 f)cince5 8y BoGld i E 1l z abed,
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Vance Searle
Agent's phone #: [phone]
Mailing Address: 221 Small Drive
Elizabeth City NC 27909
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.
�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
(DCA9 in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at httpJ/www.nccoastalmanagement.nettweb/cm/staff-listing or by 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 In�ffr ation)
Signature v
boreth kov cr6 �t
Print or Type Name
!W 5 1226U�5 AAT Dad
Mailing Address
E b'x0heth L'tv Luc r9 q
City/State/Zip
5�0-ekt&-OVC17
�a bosh, rn,rcro3�� very aan. n�f
Telephone Number / Email Address
Date
(Riparian Property Owner Information)
Signature J'
re,
Print or Type ame
/ !eR' n
Mailing Address
, ,V('� �7 7 2/
City/State/Zip
�SZ --C z/ Z-! �
Telephone Number / Email Address
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: UQV ► U d- U@ DrT(d 11 OV(.rO
Address of Property: K5 naije,e5 Actu Rya , �1�Qbey
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Vance Searle
Agent's phone #: [phone]
Mailing Address: 221 Small Drive
Elizabeth City NC 27909
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
t ey are proposing. A description or drawing, with dimensions, must be provided 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
(DChQ in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastalmanapement.net/web/cm/staff-listing or by 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.
1116i I do not wish to waive the 15' setback requirement.
(Pr erty wner Infor on)
/ : � W-11
> ,
Signature L'Ieo�%
�e�lbrrpti
Print or Type Name
5
Mailing Address
q
City/State2ip
5yp-VY&-o8g7
dehorcah. roycro5--t'®Verez�on• net
Telephone Number/Email Address
(Riparian Property Owner Information)
Signatur
`Print or Type Name D /
Mailing Address
City/State/Zip
Telephone Number / Email Address —�
Date
Date
(Revised Aug. 2014)

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