76060_Ann Vernelson_20200710

• CAMA
/ DREDGE & FILL � � No. 76060
GENERAL PERMIT j: (&t051 a # A - e C D
Previous permit
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued '-:,
As authorized by the State of North Carolina,Department of Environmental Quality
67
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC y
E Rules attached.
Applicant Name A144 YERNE L50),/ Project Location: County Bi---,a,c.-7 1 -r ;' ' .
Address 1-/-l4,to{- • !-1 w J 2 G,V- Street Address/State Road/Lot#(s) oc."-r , / /b r
City 'c-r".:-V„ C t- State !/C ZIP L'7S'�y- / 5. ? 7 7 j i 9 "(—
Phone# ( ",-) -71 iL- <::"i(7-E-Mail Subdivision /-76,r---7 ; :, r
Authorized Agent A 4-i o,- T.] -flk--r City ._47 ,,,z..,., ,-', () ZIP -) i "7
Affected ElCW /431-EW /
XPTA ICES eTS Phone# ( ) _ River Basin77 ^" --i,i`,
AEC(s): ❑oEA ❑HHF ❑IH ❑USA El N/A Adj.Wtr. Body +' ?' ?-./ 71-14'r>:c 4.41—iJPCz (nat /man /unkn)
❑ PWS: �A-.-7i.-r/cv /cidZ
ORW: yes / no PNA yes /;no) Closest Maj.Wtr. Body
Type of Project/Activity If`/) - r T c -lc) 4 F r.LI l r t-. • , S'd QePt„/kt..- tNr-1Si 13)4--,•
n
(Scale: ) ,,..2.6, )
Pier(dock)length t� '�
Fixed Platform(s) �_ >',��? Mid ! /� 7 m�
Floating Platform(s) )
Finger pier(s) '-i.,
Groin length
number ao �!
Bulkhead/Riprap length Z� ,S
avg distance offshore "a
max distance offshore -41,.' '
i
Basin,channel ( I
!
cubic yards / ..}5-
Boat ramp t 71'
Boathouse/Boatlift / 1
Cl
Beach Bulldozing II\Other �' �,
Shoreline Length 7 6 , {e
' ' irieja l'' .:SAV: not sure--)yes no L
L
iY
Moratorium: n/a yes no-) i I
Photos: yes ffd _
Ci
Waiver Attached: yes no 1
I
A building permit may be required by: L 4-'Li'"`o°? ''L.:''''. . 1 "See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions JS ,-'/1' - '7-#1/ --in--D vQ '.'..w,-.,(,
�' 4)T� Ai 1, )dr � - ' ,vGy
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature **Please read compliance statement on back of permit** Signature
Application Fee(s) Check# Issuing Date Expiration Date
t

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 (252-946-648 I) or the
Wilmington Regional Office(9 I 0-796-7215)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 252-946-648 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 910-796-7215
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

_,CAMA / DREDGE & FILL No. 76060
41:GENERAL PERMIT '— 1061 a A B , C D
Previous permit#
)G ;-'New LModification -JComplete 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 I 5A NCAC
' ❑Rules attached.
Applicant Name A i J y Y i Ale ;_ Project Location: County
Address `7-',,C. IL (--.-)- - 1-,J/ Street Address/State Road/Lot#(s)
City _ r-,. /' , , State ZIP ,
Phone# ( ) // ,1- - E-Mail Subdivision
Authorized Agent ;1 City ZIP
Affected ❑Cw ❑EW , PTA ❑ES ❑PTS Phone# ( ) River Basin
AEC(s): ❑°EA HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body
Type of Project/Activity -' . . - w - • :t
(Scale: _ G. )
Pier(dock)length
,)
Fixed Platform(s) a._.'._ s, ..
Floating Platform(s)
Finger pier(s)
Groin length
number y
Bulkhead/Riprap length r t i.?
avg distance offshore ''"A.-
max distance offshore —4' lb i
Basin,channel
i
cubic yards r� a;�� j I I
I I
Boat ramp 7`,r .
Boathouse/Boatlift 04 1I
( I
Beach Bulldozing I !�
Other ` ` ' l
1
iv rt.. F —__
Shoreline Length I%) P 4_ J
' -ti
SAV: not sure yes no .
Moratorium: n/a yes no i Fi . •%,
Photos: yes no I 1'
Waiver Attached: yes no ---
A building permit may be required by: . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
Agent or Applicant Printed Name Permit Officer's Printed Name
,.�x.1.-fit Jis."\-'S'tw___.-.-_,''
.
Signature Please read compliance statement on back of permit Signature ' `
i
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 I 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 0-796-7215)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 Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: 9 I 0-395-3964
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 J n n Verne 1 s o.v s
(Name of Property Owner)
property located at 16 !P r l de Or(Address, Lot, Block, Road, etc.)
on po,,Yide Clo.na. I , in [ , N.C.
(Waterbody) (City/Tow�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 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
qt/Vti\06,
Signature Signature 14nh irern I��1-- � 1 rhe�� �' �'1olvk1
Print or Type Name Print qr Type Name
GE L 4' G!) //iv' -to le
Mailing Address Mailing 4d{Jress
612..eQ,7v,IYz rVL 3y Kjt'41G41 /111eI lr1. i7 7I
City/State/Zip City/State/Zip
s-� - -7/44,4?343 1.52,- 7t —;41
Telephone Number Telephone Number
Date
Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /4 n 1/4 rn e )So r
(Name of Property Owner)
property located at / d , 1% i'T i d e p n
• (Address, Lot, Block, Road, etc.)
on rTs, d� Ccna. I , inChoc,oL )fv1Iry , N.C.
(Waterbody) (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 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
ignature Signature
Print or Type Name Print or Type Name
Ii'l#to <F US flu/i a i, 44: v
M` ling Address. Mailing Address
lS(.eB/7 v.%/e /V aZ1 e
City/State/Zip City/State/Zip
0?78354 ;17 :Z - _S_31 - 3c> 3L
Telephone Number Telephone Number
sue-- -2441 —(e 32 S /7 ,Zc> v
Date ts, Date
(Revised 6/18/2012)

F
Authorized Agent Consent Agreement
t P�Trt don yern GLi o n , hereby authorize/1/ To A., p, j d,- e L 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:
/t 5- 4.
C h UCJ(L j e-# / ,
Property Owner's Mailing Address and Phone Number:
te It tlj jaw € 4' L— }i7
een C',!/e
NC ), g "c
3--D-- "7/4 - 3 9 3
Property Owner's Signature:
Authorized Agent Signature: A
Date: 7 - g - ;70 a20
Form: Authorized Agent Agreement as developed by NCDCM revised 7/29/09

NC Division of Ccastai Mgt. Habitat Impact Computer Shea,
Applicant A n1 r1 V EQ r) s
Date: -p. ro . ZvZ
General Permit#: 2 G O o —
Describe below the HABITAT disturbances for the application. All values should match he name,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft FINAL Sq. Ft. TOTAL Feet FINAL Feet
(Applied for. (Anticipated filial (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Habitat i`lame Choose One includes any Excludes any total includes Excludes any •
anticipated restoration I any anticipated restoration and/or
! restoration or and/or emp i restoration or temp impact
temp impacts) f impact amount) temp impacts) amount)
I ,tip ( Dredge❑ Fill❑ Both ❑ Other ❑ i 7v f-- "7e)f .
SN/a-e..Low I I 2
'
7319 Dredge❑ Fill Both ❑ Other ❑ /��D f'- 14 o ¢}
4 Dredge❑ Fill❑ Both 0 Other e' i ?— f. 'zoo
I Dredge❑ Fill❑ Both ❑ Other ❑ i
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Dredge❑ Fill❑ Both El Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
1
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
I Dredge❑ Fill.❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑