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CAMA / DREDGE & FILL N9 77253 A C D
GENERAL PERMIT Previous permit# N 1
) New _ Modification ❑Complete Reissue Partial Reissue Date previous permit issued t•\ 1 i
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 Q1 F-F . 12D G7 .
n El Rules attached.
�"Applicant Name 'IA?LL GG 1-l1 c04_ 1 Project Location: County T,EA... owl T- _ �o
Address I Ole elce-:gt-1 S} . Street Address/State Road/Lot#(s)
City Ca'P�cr1 v t t_t.t• State to _ZIPZI g 5-fr (o to 0 '4 c.,Go , r Antis 111'1A .I rIA R," ,
Phone # (zc2)S3 I -ct(.o1Sf E-Mail 144 "A ci C Cin ; off ; 5`t Subdivision 1*l ai-tn�S y✓�llt�,y{3
e5+4.ca:l . Cow.
Authorized Agent City Oetzi4-t -1\-ro c4 ZIP Z-'7SS<NI
Affected ❑cw NEW f TA DES ❑PTS Phone # ( ) River Basirr PAmtulep
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body AA- 1• LAi J-` (nat---./. /unkn)
❑ PWS:
ORW: yes / no PNA yes / 0 1 Closest Maj.Wtr. Body ' `•"w�t')d\
Type of Project/Activity t-4 ,,-(\-. - 1'3 x 1 3 u,-16-0 t '- o k11-, �--5-
i.
(Scale: 1 = )
Pier(dock)length
1
Fixed Platform(s) , 1 I P
1
Floating Platform(s)
Finger pier(s) i f
Groin length . . „
ri
, ,
number i —_
i PrZ,jp-c)5,5 . .-
Bulkhead/Riprap length —
avg distance offshore
max distance offshore 1 i I
Basin,channel I i
cubic yards I
Boat ramp {
Boathous Boatlift + t-._..., . �...._. _..—._. — , . . _. : --
13 x t '5 t.--+S �r, t_.
Beach Bulldozing - - • - " •— -
�jc y � ;
j 3 )
Other
r c-7-
�3s
�-� i
- ,)
Shoreline Length i-� [7 I A f1 �.L !
SAV: of sure yes no d/ T1Z i0 i T '. —._. _ _...� �.iq�f Ltl' .
Moratorium: n/a yes
........ ...__.._ _. _ ._�. .t.. . .-r-i—"--- ---- - -- 1 -r — - - -'
Photos: yes �, i _._1 4' I .. 1..
Waiver Attached: yes • : 2
A building permit may be required by: r '-t�z --t ,— C cD "-3-'1--1-\ . LSISee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special ConditionsZ-e
ZDVw4:5-,\
_
Agent or Applicant Printed Name Permit Kees Printed Name
Signature **Please read compliance statement on back of permit ignature
00
6 G( atv IA 2 7Q 65C-$ f1 •/g • -r> /2- /S' -2e)2J
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 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& O
0 N . 77253 A BCD
GENERAL PERMIT Previous permit#
)C _New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ,'ti
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 , ) , •
❑Rules attached.
Applicant Name I'1 a c—L. •. . _ , Project Location: County I ,
Address - T�-Na —1 .. Street Address/State Road/Lot#(s)
City _,i._c-,--1 ,, r State ri ( ZIP .- -- •4N- ',, _ _ ...,..A..--„ I' IA.,, ,>,�` '
Phone#( ) : - i c ; E-Mail '' ' •• - i I , 17,I 1 Subdivision 1, j r=‘, 1' )(\ 1 ,i 74
Authorized Agent City 1 ''""-:v 4,-3 \-t--r ZIP --) -'t ,, 1
Affected ❑CW ' EW IXPTA ❑ES ❑PTS Phone# ( ) River Basin—TA 1 244 t l. )-v
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body 0.A A> 1 (nat /man)/unkn)
❑ PWS:
ORW: yes / no PNA yes / no� Closest Maj.Wtr. Body
Type of Project/Activity ;. ` I; ' r 1 > ' ,') -1 i _,
(Scale: I . -, )
Pier(dock)length 1
Fixed Platform(s) �,\
Floating Platform(s) \ I j ;
Finger pier(s) \ — —_.
I
Groin length ; I
number — — — +-,U,-.a i 1 ._�._.._ -+— _ ---
i
Bulkhead/Riprap length — — c'w`'� -+--i
avg distance offshore I 11 I I I
max distance offshore { i
i
Basin,channel I 1
•
cubic yards
Boat ramp I j
Boathouse/Boatl—i t \ — _.._.._...____
1—, y I -'j — — 1,-i r/P-� .
-- ---__ -
Beach Bulldozing r r 1--- i'
c�' Tk t
Other ? .
I i-pc t r1 i-11, _
j la`1 +
.14, ►-T ' rt
r„
I
1 !! I
Shoreline Length v i 1`� �4
• 1
SAV: not sure yes no ...' ,,�jii'11L —_._..___....I . v._..__..._� 1_._..-._..__........) i A i ic,X
LLk1.iY --s— ! — �,-�'
Moratorium: n/a yes n 1 . `i
Photos: yes
Waiver Attached: yes n5.5 I I Ii i1 '
A building permit may be required by: r"Y 1'Fs-1-1 ( c) i 1 1 N, . [ .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
Signature Please read compliance statement on back of permit** ignature
' ----1:-:;
r.
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(910-796-72 1 5)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 910-796-72I5
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 hJb l 04/ ,s
property located at 55s,
/de6v7ai.„ igze2zofol:i7LertOyer)
on 4160 SA1 204 (Address, LoBlock, Road, etc.)
in 60ti( FS/27— (24, , 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
—W-
i
fi
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.
i r
(Pro e 'f tion) (Adjace t Pro Ow er Information)
ature Si
mizie
Pn�J�Yp ame Print r T pe Na e /J r�c�} � /� - 1 a /�
1166���w''�/ /z/2 /'0T/u4// ,��,.5 e c CEO_y�[ �/2Il/�11-/v -c
tlin A ress 2;7TiriNd2s/A6722/0
ity/Slate/Zip ity/St te/Zip
(am).531'q i`l'I 00/0 .ct► City/State/Zip
� z - 9y3_ /9e a
Telephone um /email address Telephon Nu /email address
Date
Date*
(Revised Aug. 2014)
'Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to D
C�3 T N`
property located at ( ,,`� (Na of Property Owner)
l� 1 ` 1 '
()-
(Address, Lot, B ock, d, etc.)on A Grp {\ ) ' , in tj)Q�,b. N , N.C.
(Waterbody) nd/or(City/To County)
The applicant h s 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
•
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 t e 15'setback requirement.
(Prope a of tion) (Adjacent Pro
rty Owner Information)
•
Si /y�ieK N /4/1// Szgn
Prin, o T petva e Pri t or Type Nam e"
1%m�� th1( �ll/� &7/f AECo/75/ /��/1i.,/�A
Mailin Address r /C- MLtl✓i ey 747/v
sty/ ate/Zi City tat rp
zsz). 2.4w si r ,b //. 6 rL-ca'i �zstep 9 ..9372
Teleph n ly�irtuber/email address Telepho Nu er/email address
/3 2-0 /3 20
Datt�
Date
(Revised Aug. 2014)
"'Valid for one calendar year after signature*

NC Di-vision of Coastal Mgt, Habitat Impact Ca p-uier Sheet
Applicant_ )0 Ao. ei c r--I 1 o/J I
Date: 4 , leis , Zvz0
General Permit#:.-1 .-12 c' - 3
Describe below the HABITAT disturbances for the application. Ail values should match be name,and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft j FINAL Sq. Ft. j TOTAL Feet FINAL Feet 1.
(Applied for. (Anticipated final I (Applied for. 1 (Anticipated final
DISTURB TYPE ! Disturbance total disturbance. Disturbance I disturbance.
Habitat Marne Choose One j ncludes any Excludes any total includes j Excludes any 1 •
anticipated restoration any anticipated restoration and/or
restoration or I and/or temp restoration or temp impact
temp impacts) impact am curt) temp impacts) amount)
C..??eIN Dredge❑ Fill❑ Both ❑ Other ?:3 601 l'l i I I. }2
IDredge❑ Fill
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Dredge iJ Fill❑ Both ❑ Other ❑
Dredge❑ Fill-❑ Both ❑ Other ❑
•
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Dredge ElFill.❑ Both ❑ Other ❑
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