Davis, Jay

0 CAMA El DREDGE & FILL No. 76311
A B D
GENERAL PERMIT Previous permit #
DNew ElModification ElComplete Reissue E]Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ­W
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 17-1 1';W.)
❑ Rules attached.
Applicant Name Project Location: County
Adlclress� 677 C'/
Z
StateA V zip
Phone #
Authorized Agent
Affected 0 Cw L1 EW UFTA
L1 OEA [I HHF El 1H
AEC(s): El PWS:
ORW: yes / no PNA yes /rno
a
El ES El PTS
0 UBA El N/A
Type of Project/ Activity ly� 061 lel C) r 41.
Fier (dock) length 5
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
Shoreline Length 7 �—
SAV: not sure yes no
Moratorium: n/a yes Co
fi
Photos: yes �1i of
Waiver Attached: yes j no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of pvrmit
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # River Basin
Adj. Wtr. Body pat /man /unkn)
Closest Maj. Wtr. Body —
&" X) U kfln �
(Scale: ,r�, / f
Ll See note on back regarding River Basin rules.
Permit Officer's, Printed Name
SignaturT
Issuing,'Date Expiration

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 consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
El 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 (252-946-648 I) or the
Wilmington Regional Office (9 I 0-796-7215) for more information on howto 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 FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Jay Davis
Mailing Address: 53ci C,4rt-i -4i e U od aS C i tc k
6A-?g . AIc
Phone Number: 919.906.5886
Email Address:
[e-mail]
I certify that I have authorized TD Eure Marine Construction
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 5002 Bogue Sound Court
in Carteret
County.
Construct Dock and Boatlift
1 furthermore certify that I 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:
Jay Davis
Print or Type Name
Owner
Title
02 t24 /2020
Date
This certification is valid through 02 124 12021

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Jay Davis I
property located at 5002 Bogue Sound Court (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
On 8ogue Sound in Emerald Isle
(Waterbody} (City/Town and/or County) N.C.
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 objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
*** See Drawing Attached ***
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.)
X I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
B.I. Mansour-Agent
Print or Type Name
PO Box 650
Mailing Address
Morehead City, NC 28557
City/State/Zip
252.728.4191
Telephone Number/email address
01.30.20
Date
*Valid for one calendar year after signature"
(A 'scent Property Owner Info mation)
S re
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Print or Type Nate '
Mailing Address _
kAl 6't4,-b - t f a i - 4/4
City,State/Zip g q 3
T61ephon4 Number/email address
�� Ir611 � bUCn./ � i� •Z b
Date''`
(Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
t hereby certify 'that 1 own property adjacent to Jay Davis 'S
property located at 5002 aogue soma Cou,
(Name of Property Owner)
on aogue Sound (address. Lot, Black; Road, etc.)
. u��;r,erala is'<v , N.C.
(Waterbody) (City/Town and/or County)
The ap ant has described to me. as shown below, the developmenA proposea at the above
locatia .
X I have no obiection to this proposal.
I have objections '-o this proposal.
DESf:RiMiOid ANDiOR D-RAWING OF PRO *Q$ED DEVELOPMENT
(lrrdividur l proposing development must fill in description below or attach a site drawing)
Le `..7r41�ifing Attached Y...
V4/AIVER SECTION
I understand that a oier, 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
f you wish to waive the setback, you Must initial the appropriate blank below.)
iC 1 do wish to v;aive the 15' setback requirement.
l do riot vsh zo waive the 15'setaacl , aquir+ern
(Property Owner it 0rrr'jatior,)
(A ceEnt property Owner In ation)
5.1 h^snsour - Agent
j
Print oi- Type
PO Box 65u
�f'rr�t 1if 7�YiL. 1'�3%Ir'l
�*—`
Mailing Address _ __
AAfJW✓G��
Mcrehea� City, N. 28567
City/sTate2ip
ivEailir�q Address
25212a3 419`
Telephone Alumtrsrf e naiJ address
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61.30.24
_15ephrr; Ni�,mberl email address
s
'Valid for ore calerrdar year alter s;unatur-.` (Revised Aug. 2014)

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