78603A_White, Earl & Dennis_20200518

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I/CAMA 1 --,k6RFXME i FILL NW 78603 OA B C D
C�. ENERAL PERMIT Previous permit #
New i-Modification --;Complete Reissue -- Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department ent of Environmental Quality
and the Coastal Resources Commission m an area of environmental concern pursuant to I SA NCAC
attached.
Applicant Name. 4 nPn,.:S J,JL,`� Project Location: Courtly � �,' L._.... . .............___ __ _
Address )Cam S racu< rn 1 .�. Street Address/ State Road/ Lot #(s) 112 t i ! S
city Aaw bot-o _ ---- stated zip 7-3 m t, e L; L at. ter,') 6 +
Phone # (3S,) �2ai'').%tt E-Mail _._ �_._____ _ Subdivision TcI� �S�aiGS' Sic �
Authorized Agent �_�+ t 1 CnY t� 7JP93 q
Affected C7 cw nEw i�PTA Es YpTS Phone #. (i) -- - River Basin -`—D
u 0EA r HHF 7 IH CUM I N/A �^cj ) [SG j kn
AEC(s): - - Adj. Wtr.X _._.�. _.+ (net /an /un7 ® )
tom: , � t
.� ('Inccct Mni Wtr Rnriy Cl-tt
ORW: yes / n}� Pl`4A yes l no'l
Type of Project/ Activity &(k4 ec - RPM er,, & 4-
(Scale: I"
Pier (dock) length _
Fixed Platform(s>
Floating Platforms) Finger pier(s)..le
y
Groin lengthn --- -- — i
number
kh Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubkyards­
Boat ramp i
Boathouse! Boat%t
Beach Bulldozing
Other - -
i
i
A building permit may be required by: ,' I U - See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ special Conditiorts
aaSltl:i... _ I_i
Agent or AppiiwtK Printed Name
i a e: Please read statement on back of permit"
g^azt
Application Fee(s) Check #
PermitOwmer's Fretted
1
Signature
S- ►I-ao
Issuing Dace Expiration bate

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
0
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all C MA Permits necessary to
install or construct (activity) Foleh ! ,
at (my property located at) 6 f l
This certification is valid thru (date)-,
Property Owner Signature
Date

0, 06,riiptete items 1. 2, and 3.
0 Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of ttlemagpie..,
or on the front if sacce Permits.
r Atoms _ -
Ot
9590 9402 48219032 5
A. Signaturo
Agent
Adftseis
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f" {FNnisd hr) . C3�teAOD:%,a)
D. isdelivery address different from item 3? 1j irea
If YES, enter delivery address below:
ivo
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City County)
Agent's Name ##: ��� ( Mailing ddress. 'YO
Agent's phone #: -1,
...�..os ..ems.. ��....
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 oposing, 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
(DCM) in writing :within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909, DCM representatives can also be contacted at (252) 264-
3901 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, 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.
(Prope weer Information)
rratzrr
Print or Type Name
Mailing Address
CitylStatellip
Telephone Numberl Email Address
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatelZip
Telephone plumber / Emai Address

TiD
....... . ...
MW
Postmark
Here
05/04/2020
• Complete items 1, 2, and 3.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
IV 17?,
II I IIIlI! IIII II I llllil l lill IIIIII II III I ! l Ill
9590 9402 4821 9032 5378 51
Arfirl- hl-
7019 0160 0000 9887 1788
PS Form 3811, July 2015 V)SN 7530-02-000-9053
I Agent
x N AddW
r_. t14 of ii
B. R leiv by (, "Inted 14atnk' ?a
ii
17
D. Is delivery address dr9fferrent from item 1? Yes
if YES, enter delivery address below: p No
3. Service Type
priority Mail Expres'
UJ Adult Signature
0 Registered MajIT14
E) Adult Signature Restricted Delivery
0 Registered Mail Rey
0 Certified MailQO
D Certified Mail Restricted Delivery
Delivery
0 Return ReceiPt for
Cl Collect on Delivery
llect on Delivery Restricted Delivery
Merchandise
E Signature Confirrm
ured Mail
0 Signature ConfirMa
,.,,,rr--ured Mail Restricted Delivery
Restricted Dak'Very
Dornestic Return Re

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