Mintz, Chris

❑CAMA / ❑ DREDGE & FILL N9 78977 A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 1 � "/ r
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC��`f
M Rules attached.
Applicant Name ` Project Location: County
Address (4'� Street Address/ State Road/ Lot #(s) `f/ ,%r =€ar }
City'',o�y, i'tn State ZIP
Phone # ( ) �' E-Mail Subdivision
Authorized Agent -i_f ,� ,', ., City ZIP
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin t i.7 ((
Affected ❑ OEA ❑ El ❑ IH UBA N/A
AEC(s): ❑ PWS: Adj. Wtr. Body (nat /man /unkn
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body��f`)
Type of Project/ Activity
Pier (dock) length_ ?`''�
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap len
avg distance off
max distance o,
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other G (i,
Shoreline Length
SAV: not sure
Moratorium: n/a
Photos:
Waiver Attached:
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
i
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale:
❑ See note on back regarding River Basin rules.
I i
Permit Officers Printed Name
a Signatu r--
11)
Issuii4g 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 1) 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, certifythat this project is consistentwith 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 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/ I-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:
Mailing Address: /o s I/
a�clS /yL 271--x);—
Phone Number: i `� +7 l v C 7 `p
Email Address: �� r►'��r �Z �,�. �i1?? �,` !• Cp/A
I certify that I have authorized
A ent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
F
JP
at my property located at ..2 l Z } A %�> ► Z��,E'1 �G�.i�� ,
in 6, ­4'el,64" County.
l furthermore certify that l 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
!o"Xt-L
Print or Type Name
Title
2 I Z -7
Date RECEIVE®
MAR 16 mo
This certification is valid through I I DCM-MHO C1

r i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Pr perty Owner)
property located at 212 Oc k ter-1- 0,1.
(Address, Lot, Block, Road, etc.)
on 13��}i tt SEA;,.-� , in oo.C�_# N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
IocatiQn.
I have no objection to this proposal.
o�jecti_on-s_to_this-pr_opasaL----------.-_----_----- —
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must Fill in description below or attach a site drawing)
2 Z y
W_ A117ER 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.)
Yr,rn I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Own Information)
Sig
P tore Sib e
Print or T pie Name Print or1 TvD ;f.�-. �Vame
rd
M 'fing Address — Mailiog Address
City/S t te2ip City/ fate ip
Telepho e Number RECEIVEOTe/eph ne Number
, zv
D to D to
MAID 16 2020
(Revised 611812012)
DC M-i1NHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ` -%' Gn rye,
(Name of Prover Owner)
property located at 2 1"2
0�
C
(Address, Lot, Block, Road, etc.)
� ,�5 1onNC
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
x— I have no objection to this proposal.
I have
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
i
IN
Ll •�t
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin
back a minimum distance of 15' from my area of riparian access unless waived by
wish to waive the setback, you roust initial the appropriate blank below.)
C - I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
must be set
me. (If you
(Property Owner Information) (Adjacent Property Owner Information)
Si nature
Print or Type Name
ding Address
V,cI 5'L & 2 ?�fd
City/State/Zip
91e?, "7� d 661-'X
'('C,t ka', ` - e('C.. ee/ 7---
Signature p
W e I ( S �d wl id It&SCrbt
Print or Type Name
-+6 M,4b'
Mailing Address
City/State/Zip q (a 6 ( O ( r(30
Tel h ne Number Telephone Number
� Ili ( • 3 2Di-v
D fto t Date
6 Z020
(Revised 611812012)
ki
Dc -mHu elly

NC Division of Coastal Management
Cashier's Official Receipt
Received From: � D1a-k
Permit No.: zz $9//// r C- ,1
Applicant's Name: �r►5 /"� ✓��z
Project Address: a 1 a Oa k 1poF 'Dr i? K 5
10018 ABOD
Date: 3/? 201"
$ �00 - 8a
Check No.: "('0/
County: Car-/V(' eY-
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: e Date: �a�
-S/
Signature of Field Representative: ,//�'�{ �2f(� L, �_. Date: �� °W