78573A_Walsh, George_20200316

EJCAMA / ❑ DREDGE & FILL N� 78573 et D
GENERAL PERMIT Previous permit # A B C
XNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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
Pfl Rules attached.
Applicant Name Cor wo(Sh Project Location: County CRUD n
Address 86 isa r a y q bC . Street Address/ State Road/ Lot #(s) La ( j (0
City_t:.:)i Recda:_t> State Ni' ZIP ji 75 1 ( ['l�nir
Phone #( ) >> `LiUZ� E-Mail ACC, c,x,1'y131@cwl,ccSubdivision
C x.t;1'. ''luh ( c �d „c.t
Authorized Agent a f1-01 tort (,c, pl City ZIP 2
Affected ElCw ® EW ® PTA ® ES 2 PTS Phone # ( ) River Basin c
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body Ca n n 1 (nat /manu
ORW: yes / ffo . PNA yes / io
Closest Maj. Wtr. Body „ �.A t
Type of Project/rActivity L
Li
",U f- ,,;; bCCiQ
(Scale:
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
............ ..............
._ _.-.......... . ..........
F
Groin length
number
_
_1 -
Bulkhead/ Riprap length
avg distance offshore
I
max distance offshore
Basin, channel
cubic yards
- X
Boat ramp
-
Boathouse/ Boatlift
1 '
Beach Bulldozing
i
t i
—
Other —
Shoreline Length
2
SAV: not sure yes-
Moratorium: _ yes no
..... _ ..
- �1
t- - i
Photos: yes no
_ t i
__
_ .......
Waiver Attached: yes nq
A building permit may be required
by:
j'
U UCt n C, 0o 11
See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
,llh' 0 t_ ,� /Z/_
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
�rYr�*lJ*
Application Fee(s) Check #
PermitOffiEer's Prfntedj;Name
Signature
3/1(, /I �/ i.2C,
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 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, 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 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Ue� o
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
7 An
i
Agent / Contractor
S
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1-/
at my property located at
in ��r*OW 0�'-'n County.
l furthermore certify that / 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
ce - a
PrOf or Type Name
Title
Date
This certification is valid through 1 I

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ADJACENT RIPARIAN PROPERTY ��OWNER STATEMENT 1
I hereby certify that I own property adjacent to 1\� �� ��SV\ 's
k �.,. (N a of Prope ner)
property located at
on
(Waterbody)
(Addr4ss, Lot Block, Road, etc.)
_
in C' U� , N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc tipn.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
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.
Ow er 777) l
,�,
�gnqqr&--'
a
i' Addr, s�n
City/State2ip
Telephpoe, Numiker/ema address
';& \CL-A �
Date
(Adj c t Property Owner Informati
rc -
Sig tune * 1,
�—}'
Prior Type lime ���
o u ->�,e,
Ma �A�ddre oX ? y'3a
City/Sta" 7-�n 7
Telephone umber email address
�1 cy��
Date *
(Revised Aug. 2014)
*Valid for one calendar year after signature*

C 1 O
1-7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to &M �a��y ��est`N'c�C. \-� &\5y- 's
'` A � %. � (Name bf Prope wner)
property located at ocU)
on
(Waterbody)
ress, Lot, Block, Road, etc.)
in V--, N.C.
(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 rill in descriptiow below or attach a site drawing)
31� 5` w ooc\ C-N-Ocv%
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.)
4 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sure
Print or T e Name V\.
aSA coov'VK Uwb Ov;v�
Mng Address
e�.n�w
City/State2ip
Telephone Number/email address
Date
1 lrT/' 1 111
Type me I ub
Address �.
Telephone Number / email address
6;2 -d 9y �
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*
�Zx7t ((non

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