76034_Tom Randolph_20200619

76034
0 i___CAMA/ DREDGE & FILL No. A � C D
GENERAL PERMIT 3'Q.W1oLORI Previous permit# i
> 'New ❑Modification ___]Complete Reissue ❑Partial Reissue Date previous permit issued )fi
G _
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 I 5A NCAC '-'-�-1 -1 i 2 ' .
ID-Rules attached.
Applicant Namrvyr 'F'-Ap---),'")ac. 21-4 Project Location: County 6 A3.-4.1 t.r
Address "2-V ? ? S. 0 1-- '77 . . Street Address/State Road/Lot#(s) > 5/L )) / l't.<„
City /-hi�� , ; 7 v State ' IC- ZIP 2" '*- / / -c. 2 U I=oz ' > P c
Phone# (--2(:.) 2Cv3' - '/4 y E-Mail Subdivision w.c.- r 1, ,9 r--
Authorized Agent N )i City ','- -- "'-a-,-i t I ZIP --a--?SS r---)
Affected l- Cw LEW t TA ❑ES ❑PTS Phone# ( ) River Basin/N.-"AmL r �c.l
OEA ❑HHF ❑IH ❑UBA ❑N/A ,
AEC(s): Adj.Wtr. Body /`" •'1-i I' ,-i " - /mil} /unkn)
- PWS:
ORW: yes / no PNA yes /'n� Closest Maj.Wtr. Body r'"c-' '0 '2 r '-'t,\
Type of Project/Activity f-!5-/lt_,. ' /3 ' , 1 ►3 i ' '""4,v6}r e- ,. 5,),6rT2 , f;-T
(Scale: f'I IA, )
Pier(dock)length
i I
Fixed Platform(s) } — I i '
_ {
Floating Platform(s� I l r 1
Finger pier(s) Lf y 2.S ii/IS l —I
Groin length "ItI I II . i ,
number _a } I 1 �I --r- - i
Bulkhead/Riprap length i i j
avg distance offshore
max distance offshore
• i !
' WI ill_
Basin,channel _ __..___ ! �� ! 4 /
'�
cubic yards I._._._._.._ _
`
/ I
Boat ramp- I I 4 �! -2 r-, ti yt /2. : y►r s-rr," )rni j
Boathouse/Boatlift7) (q-'/p vb7 F.'/) • -- E 1 RJ(- s Li.4 5 r I
L.. r art-+
Beach Bulldozing I i ! 5/('►jl '
Other
Fl ilLYIft !
Shoreline Len ! f v i f� i 1�i ►� } i I' ` l
1
SAV: not sure ,�yes - _... ; i 1 1 I j A 7�
Moratorium: n/a yes n `1..,. .ii7!> .Z�>L P 1-L�. I L
Photos: yes ` � 'r �, �Ic-
Waiver Attached: yes no 1 • i
A building permit may be required by: f3F'R1 1 l'' . . ©See note on back regarding River Basin rul\
(Note Local Planning Jurisdiction) -
Notes/Special Conditions '') 4 ''-,,)Tile--'t a (-/1.�v><1 , 7)2 N C T.,!L 1-- S 7- 5.---/ "
1.t--y) /-• /4,- 1-o 6e1 t lf}t
Agent o'Applicant Printed'Name Permit Officer's Printed Name .
NS----------'
Signature **Please read complianc `..ement on back of permit** Si at re
�lA,I1 1' 14 0 '''"'"-/- 1 v 60 ) 9 T U�*- '2 O / f\ b li t 41 b e/A 267.6
Application Fee(s) Check# 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 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(9 I 0-796-72 15)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 252-946-648 I
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 Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 9I0-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare, Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 7 0M �„ .de 's
r� Q Nam 9f Property O er)
property located at a `i PP'j 6 ,5 (eM , �t� e C
on (� j�� V l /(Address, Lot, Rlgck© , etc.)
(Waterbody)e n�( (City/Town ounty) N.C.
c.
The applicant has die cribed 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 fill in description below or attach a site drawing)
n
WAIVER 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.)
I do wish to waive the 15' setback requirement.
&o not wish to waive the 15' setback requirement.
�((PPro�perty Owner Info ion) (Adjacent Property Owner Information)
/ Chi ,14 �..__ —A
Si nature �J rat.
(i i_
Print©p me Print ripe Name
A `i o F Ts;�� 0 C -25 Le s /i )ln�-,nirtISTheach lec�
Maili g Addr ss Mailin Address
ra
y/Sate i City/State/Zip
� �� 90I - 3Z� - Go1v
Telephone Numbb r n (` Telephone Number
D J l�f+ 3 75162,ate Date Le1is ' -Lo
d -1 7 .'c2 (Revised 6/18/2012)

Authorized Agent Consent Agreement
I d o p0 , hereby authorize ' 1n 2 ty-y to act on
(Property Owner) (Authorized Agent)
my behalf in obtaining CAMA permits for the location listed below. This agency
authorization is limited to the specific activities described above.
Property Address:
y Pottsi die 0 r . .
6 h,tp co Lv.9 1 ,c/C •
Property Owner's.Mailing Address and Phone Number: ,
nn o.? 5I et r�-S %�� �p7 r
(i � cocv1r1 Cc-
•
• P�4tia��%
Property Owner's Signature: , ldyn-
Authorized Agent Signature:
Date: G ^ G!
Form:Authorized Agent Agreement as developed by NCDCM revised 7/29/09

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ►kt k C: }/ U ��
property located at ca
lt /1 j2o (Name)ofkProperty wner)
• /d
POt
(Address, Lot, Block, Road, etc.)
on �- , �t F° C 0 Ac ( , in l'eo 4 , N.C.
(Waterbody) (City/Town an 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 fill in description below or attach a site drawing)
WAIVER 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.)
I do wish to waive the 15' setback requirement.
1. I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Own nformation)
Si nature Sig/napire
Print or Ty Name Print or Tye Name
torts ;�1� V� _ ' p6 ers,D ,I)R.
Ming Address .11 Mj in Address
Cd[IA Kam)y l _r] aCOckif/✓i 1`1
City/,Stbt ip n / City/StCe/Zip Z 7 ( 7
Teivph,paq Number Telephone Number
144. 10 013 -.7s' -� Zsz VC 2. 7,5t/
Date Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to `tr> yrt A --1,4e r'4-- . 's
Name of Property Owner)
property located at 02 I*/ Po r
tAddress, Lot Bock, Road, etc.)
on AC:Or4.5 C A it ) , in ( kc , N.C.
W�aterbod (City/Town a /or County)
( ty
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 fill in description below or attach a site drawing)
WAIVER 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.)
�t/ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Si na ure Sift re n
D yptrP C t icA,a* � �" !
Print or T N me Print or Ty Nano
ad s Ian Pr- �.y , J ,
MA/Ng Address Mailing Address
C. .f) e',0 Cl/( C
City/ tat / City/IC ip )��
Telephone Number g Telephone Number
Date r ` ` LIAte
(Revised 6/18/2012)

�4C Dtvisxoty of Coastal Mgt., Habitat Impact Computer S3,eet
Acplicant:�0A1 pe4
Date: /9 �4,01� 2.4 2D
General Permit#: 9 iv og _S,
Describe below the HABITAT disturbances for the application. All values should match tie name,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft ' FINAL Sq. Ft. TOTAL Feet ! FINAL Feet
(Applied for. (Anticipatedfiral (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance Disturbance disturbance.
Habitat Name Choose One includes any Excludes ?ry total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or emp restoration or temp Snpad
temp impacts) impact am cunt) temp impacts) , amount)
�.i '
P
Dredge 0 Fill❑ Both 0 Other 0 2 s 3 2
Dredge❑ Fill 0 Both ❑ Other 0
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both D Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
•
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both ❑ Other 0 I �
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑ f
Dredge 0 Fill 0 Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other 0 J
Dredge❑ Fill❑ Both ❑ Other
Dredge❑ Fill❑ Both 0 Other ❑ ,
Dredge❑ Fill❑ Both ❑ Other