77254_Kevin Bush_20200824

--RK_5
ReCAMA/ ❑DREDGE & FILL - 0 j�r �7/ „�,725
GENERAL PERMIT �t N9A (9 C D
Previous permit# �/ a
ew ❑Modification OCompiete Reissue ❑Partial Reissue Date previous permit i ued ./I/�,et
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 I5A NCAC O7/i ,'2pp
� L u attached.
Applicant Name__464ije „,__
f/ Project Location: County /Jt°.ta. 0•-•
Vd
Address
V/V A//r(1„___,r,z" i-tH Y
Street Address/State Road/Lot#(s) /77
City �e,,i4 State"et ZIP Q?7 0V. ,thr L-o„/O L / . cil
Phone#(F/9) /,?-000, E-Mail Subdivision
Authorized Agent /• , 'f .-,i,e- City ZIP '8', _
Affected o CW f W I5PTA ❑Es OPTS Phone#
0 OEA O HHF O iH 0 USA O N/A ( ) River Basin�r/ �,.,
AEC(s): Adj.Wtr. Bodyc / a /unkn)
0 PWS: . Ur .c..
ORW: yes /(3 PNA yes / Closest Maj.Wtr Body_....A___ __ ' " Ale-P.
Type of Project/Activity R.esi'zie
ari'te wdv /.3` -/ ' Uc4-//�
�e eh:-.i4�� fp,e.- 1-i.a` /��
Pier(dock)length_ (Scale: = J? )
- — I -1-------
__ .--
Fixed Platform(s) j--: _i , I i -— ' 1 ^ 1
Floating Platform(s) i Jo/` (A-a j -I , L! i .+ d _ -•- e ! 1
I
Finger pier(s)
i ) . _ �_ _ _iL_____1,ri. ,Groin le h i 1- ! : 1 , F1_..r�- ,number -L'---1_ 4... i 1 i i ! 0 ---Bulkhead/Riprap length . , . i ... ; i .� r ® 4 - �_ !._
, -
¢ i —• ! � i hF i i t
evg distance offshore , . i , /( 1Q -L_ {__
l�- / ��ist P- f
max distance offshore i a , I I- �_ t ; d'�✓�:I�r"�h i ( j. _.. .. __i
}
Basin,channel I i j M `y j
cubic yards - 1-- i 1- i-I -,- ` ,-.-
Boat ramp }., t --1— i + ' i. ! ( - , __ ._ _ _4 _ y
t—t
Boathouse/Boatlift , -i -_- I 1 ' -T f _ --
: _l_
' !' --4---'t I I ,---r- I- ; i A/-.J4H,_,..-k- i . -I -------- -t- -- -----
Beach Bulldozing _ . __ i_,' l
Other I -�- I ! t_ i I ! 1 j --I- j -
1- ,
-4 —. • f
. . 1-4 - __ i . ex,.-/ _
/ t �
Shoreline Length�__old- -i- � I i--- f _
t
,�—y j .1.4' ! ' I
SAY: not sureyes h/ I '
I � t
Moratorium: Na yes P� a _i_ . • ' 1 .. --' I !-
Photos: yes no O i .AI i i
s
3
Waiver Attached: / e no I - , I .f- i ` �. , ' 1 _ .._ 1 '�� �1 1 _' I [, .,I t
A building permit may be required by: ./e-<h i/' Ce �;note on back
(Note Local Planning Jurisdiction) River rules,
Notes/Special Conditions Sec 07/i/200
t
i�� / 1,
A lican rimed Name A`� �"`4vtG S 4.y/���
PermitOfficer' Printed Name /
Die6'14 ----_ -
.es2
Signa Please read compliance statement on back of permit's`* Signature
.`'—`emu// 407L/ -20.20 Deee; ,L aC (/ =C1.20 I
Application Fee(s) Check# IssuingDate
Expiration Date

0 L'CAMA / ❑DREDGE & FILL N° 77254 A ® C D
GENERAL PERMIT Previous permit# ,f/7i
)C• ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ii///%/
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 I5A NCAC (_ ! /
(e .-,,, � ,. / �� ,.L Rules attached. `Applicant Name ix.A, I' Project Location: County / e.", , ,/;.
Address 616 // 1!�N j" Street Address/State Road/Lot#(s) 17 j' /✓i - '-r
,1 L
-7 / p
City iF` ,j State �� ZIP 7��(7 f-.., /6• Loin l:. %7 �rie-,-`i .:::;„ r /�`
Phone#(2/9) ,1/2- oO/ E-Mail -- Subdivision / -
Authorized Agent 7Y 'J ...,.,s City /lr X e-s.e A ZIP /cS7/
❑CW LAW [ A ❑ES ❑PTS Phone# - River Basin <r//
4N,,
Affected ( � /-_
AEC(s): ❑OEA ❑HHF ❑IH 0 UBA ❑N/A Adj.Wtr. Body 16,,L .cf/` /< Cf ec 1 an /unkn)
❑ PWS:
ORW: yes /(no PNA yes / Closest Maj.Wtr. Body ,j 0 ��'
Type of Project/Activity A.,, II o r,t e pl e /3'r /7 ' ' bo /// / -J /), '< ,/( //
(Scale: / u�0 )
Pier(dock)length
11
Fixed Platform(s) _ ; I ill i ( I
I �t,eti� 1 I i
Floating Platform(s) i d `
' -i , ,
/ ia ! 111�/
Finger pier(s) r •! i. A T_—__,
Groin length I
J
number �.. ...._ I _ 1
Bulkhead/Riprap length — I .-.t_... �. {. .. .. ).! `
uA / i
avg distance offshore I d ioJ,J 4,j,
max distance offshore f l E .a,<r 1it k 3
Basin,channel { r v f--' /
cubic yards
Boat ramp i i ,
i
Boathouse/Boatlift ---...-_---- .-_. _
f
Beach Bulldozing f
Other i ; ( .
i.......:i...L 1
•
f I I
f �e, J
E,, . IT'S - /�
Shoreline Length 60 1
SAV: not sure yes no -- �t /
~ lJ i-,r L -
Moratorium: n/a yes 1 r d . �� �(v,(.[1.�._
i c 11vv
Photos: yes no too -..-.z_ _i �.
Waiver Attached: yes' no I • , I i .
A building permit may be required by: C-) 'ti 1/ / ( . 2 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions rf 0 7///700
614 <., E /1 .�74,A J
Agent or Applicant Printed Name Permit Officer' rimed Name /
Signature Please read compliance statement on back of permit CC Signature
-
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(910-796-7215)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: [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 N9 77254 A / C D
GENERAL PERMIT Previous permit# ,
�� ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued •/�-9
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 /, / FEU V
/ []`Rules attached.
Applicant Name e ,,:,, /,, �. Project Location: County
Address %C> /1 /7.,,, / Street Address/State Road/Lot#(s) J / ,
City i State /fit ZIP , / , //% `A// `,-- /, /'
Phone# ( ) E-Mail "- " Subdivision
Authorized Agent `/. , City
..Ci /--: ` , e ZIP zf /
Affected ❑CW ❑EW ElPTA ElES ❑PTS Phone# ( River Basin / lig,--,"
❑OEA ❑HHF ❑IH ❑UBA ❑N/A r , k (nat /man /unkn)
AEC(s): Adj.Wtr. Body
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body {� f 6"
i
Type of Project/Activity / ' rf,,
(Scale: / ,'l, ) a
Pier(dock)length
j . I I
Fixed Platform(s) : I ( i I
g O _ ■■■ ■■■■ i/■■■■■: ■ - ► //,,
Floatin Platforms
Finger pier(s) (._ f. ' �w_ 1.......... ■
Groin length j
number a......{._......
I
Bulkhead/Riprap length ■ 1 I III . -1� . .ti) i ii i 1 ■■
avg distance offshore 1111.11111111111111111111— • .'■II ra r ; , ■
- 111111111111
max distance offshore z i I. /F 1
Basin,channel i 3III
111
cubic yards 11111111111111111111111111 , I 1 1 , ■.i■ 1111111111111111111111
Boat ramp
Boathouse/Boatlift i 1'.. ..
E
Beach Bulldozing _
■ ^i y_ li ��■ i ■
Other
I I : I I : . i
i � I
mu H■■■
Shoreline Length ' (�' , immogniiiiimmammioramo
�1 ■�1■� ' I ■■�1�� _� NMI■■
SAV: not sure yes no �-� - Immo d)
Moratorium: n/a yes no t ,i : I i,
10111111 r
Photos: yes no , ..... .. .. / �_ 1 t...
t __
Waiver Attached: yes no — I
r
A building permit may be required by: ` ! 0 . I:' See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions ?I,//-7 00
Agent or Applicant Printed Name Permit Officer's Printed Name /Signature **Please read compliance statement on back of permit Signature /!t� 'J
/
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 (252-946-648 I) 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 252-946-648 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

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(910-796-72 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

• 1, AMA / DREDGE & FILL N°. 77254 A S C D
G NERAL PERMIT Previous permit# it/ A
��--- I NNew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit ifsued ✓(//,4
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 071/ /„20# .
Q'Ruie attached.
Applicant Name ,e�v v/r, gr/ Project Location: County l..t'u er/ C..or
Address 1j/‘ 1/0/%h X/ Street Address/State Road/Lot#(s) /77 /;� .-#4 s'
/
City I ��,si State A/C ZIP v276 ( A ��te �pv/o Li �J./r/ci/,ni i t 1e'
Phone#(9/4) 122-000/ E-Mail —�— Subdivision
Authorized Agent 7✓r f /'ram,-.1.^e- _ City //G/cvc., ZIP 02 717
I
Affected ❑CW I6W EPTA ❑ES ❑PTS Phone# ( River Basin r • t r_
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body Jp r-Ica, C...-{Ye-i na an /unkn)
❑ PWS: /�
ORW: yes / no PNA yes /� Closest Maj.Wtr. Body Alpd re
Type of Project/Activity f'1 cr Rd r;t t H L4,-: /3()`/-7 doe/// Jo ex,•.r A..7) /Or ei 'jo/Melts
(Scale:
/ "?O' )
Pier(dock)length _ _
Fixed Platform(s)
J
Floating Platforms) � ^r�A j ®i !b I
Finger pier(s) (.r/ re 7 I i.. ! r!
Groin length T- -- ! 1
number I_... _T_..- p ® C
Bulkhead/Riprap length . ---- . . l 1'h P'
avg distance offshore i ,p1S ,M�
max distance offshore + H 1 1 /
Cn k
Basin,channel - /1 G 15 I
cubic yards
Boat ramp j I _Tii
Boathouse/Boatlift ,-- •
— r — ; --- ..----____
_ _ +- I.. N r f -
- . !
1 i I
Beach Bulldozing I —
Other i
4 b; 4kI
Shoreline Length 6 4
SAV: not sure yes j
Moratorium: n/a yes o —
Photos: yes no _. ..._. I � .. > . — �_
—F— 1
Waiver Attached: () no 1 I ! _ I
A building permit may berequired by: be—eh, er . I/I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) //
Notes/Special Conditions .See 07i 1200
$/1_46,G C.- S- /Gf
Agent or Applicant Printed Name Permit Officer' tinted Name
G7
Signature **Please read compliance statement on back of permit** Signature
I.2O0 /.767, AA. j µ// ,2 t/, �.�.o Deu.,�., � �o zv
Application Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Eereby certify that I own property adjacent to I.!`r ik) IL' Li
,s
�roperry located at 7 ,Name of Property Owner)
yici �Lic,,e 1,e o t
Address, Lot,Block, Road,etc.)
n APB 'c»4 ( �i-tk. , in fel4,4i/ r.1 N.C.
Waterbody) 'Citv/Town and/or County)
he applicant has described to me, as shown below, the development proposed at the above
•-ocation,.
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
o
1
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 I
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15'setback requirement.
do not wish to waive the 15' setback requirement.
(Props Owner Information) (Ad1acertt Property Owner Information)
Sign re F,.n e*
3t01ts,‘
Print or Type Name � `x
Print Type Name
ire ;/ /1t t) 5/ .2 ,. ,Bee eItw arc i Cr:
tin Ad Mailing Address
fi
I A LI 2 7 61 / Tor b ra rco j A,C d 788�n
;jilt .t Z-ce, f City/State/4
Thies' oni9 Number/email address Telephone Number/email address
c1f 2 o 2 a s- %20:2e)
Date Date*
(Revised Aug. 2014)
'Valid for one calendar year after signature`
1
j

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i.t.iI,J ,,,,s G l 's
(Name of Property Owner)
property located at l_ r e PS oS ,k L cuuP
(Address, Lot, Block, Road, etc.)
on i-o re)r.�..--, it e1�
in {_L4.:A.s
(Waterbody) N.C.
(Clty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca ion.
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)
is C
v
\E ,Nii
X ..k*
k.
k
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.)
do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Adjacent Property Owneformation)
St-nature Si inure*
Print or Type Name P "nt or Type N me
Lof 1-4fr.) 17 Yf . ce L�`�..- r�'
Mailing Address r� �,j t
Ma'ing Address
)
City/Stefe/Zip City/State/Zip
?I i".&12 -od a/ 2. c#1°
Telephone Number/email address Telephone Number/email address
C/1gI24, 2-52.. a/ YY - bs/3
Date Date* 6111 z 0
*Valid for one calendar year after signature (Revised Aug. 2014)

— •
1
ADJACENT RIPARIAN PROPERTY OWN ,R STATEMENT
I hereby certify that I own property adjacent to & ;te_ I____LJL4____________'s
(Name of Property Owner)
property located at (7 '7 Irp"Xi : --'4=•-.— C.. ..07 (c -
(Address, Lot, Block, Road, etc.)
on -To,"‘-,•CA./\ 67,e e_ V--- , in Se_L In..4.,)10-r'j , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. -
1- i have no objection to this proposal.
Artior*rt
Property
Owner I have objections to this proposal.
'asecic cr,c
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
8
WAIVER SECTION
"kdiaCtr:
, rt7 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.)
ifs i P
1pp do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
(Pro rty Owner Information)
‘..- ,t4 0--
i ,-,...1*dia7Lerty er Information)
Sirtgpire D z (-" ature*
l'(4.11 V P&P 63 I ‘4Z-T)Di.:)
Print or 17eP9eme<
ogyr Type Name_ , •Dr
M 'ing Add ss .--"WI Addth
Z7L _i_...t-- VEK)
y/Sta ip Cityltzet/Zip 7 ,To
Tale*on9 Number/email address Telephone NunOrenaii adgiajs,:::t
00
Date Date'
7,.._z_7....c3 Da 0
(Revised Aug. 2014)
`Valid for one calendar year after signature*
- --

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Hereby certify that I own property adjacent to ecol fia Sol L i 's
, Marne of Property Owner)
,
;roperty located at
Address, Lot, Block, Road, etc.)
in V e Oh 44 cie.-^, , N.C.
Waterbody)
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lOcation.,
have no objection to this proposal.
Pivverty
°view
I have objections to this proposal.
Coe=one
e"".".."-.."7".--*XSCRIMAWORT)RZIViNG OF
i-T6F-VEIT.OFEN:17----
(Individual proposing development mast fill in description below or attach a site drawing)
i
,
(-;
_..„,
WAIVER SECTION
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.)
tiv&. do wish to waive the 15'setback requirement.
do not wish to waive the 15'setback requirement.
(Prope Owner Information) (Adjacent Property Owner Information)
7 14 IF
;eV
3igitabure Fignature*
k VW 4#19
Print or Type Name_
(01 ;)liald For 5rt- PrAi9rf 2479/Name
Mailing Address Mailing Address
k i 7b0r7
Xs./ -,77e> re1U Da-.
I
cirp
t, ta _ ,PP-t-t,a4,7 .e h ft-v•cA).1
Teledhonp Number/email address Telephone Number/email address
Date
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*
4

ADJ GENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that i own property adjacent to
tli« 'S
3roperty located at '7 ��lame of Property Owner)
:n_ .r C�cr Address, Lot, c , Rc ad,etc.)
Waterbody) in p` G 1-1`r` n1 , N.C.
(Ci tylTown and/or County)u ty)
The aoplicant has described to me, as shown below, the development proposed at the above
,ocation.
" i have no objection to this proposal.
I have objections to this proposal.
OESCRlPTtON ANIDIOR QR.AWING OP PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
�L,a.S: b'YP�!®Y ER ys�C 7 t®I i
: _� I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin II
-_. 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.)
r4zr`� qo wish to waive the 15'setback requirement.
do not wish to waive the 15'setback requirement.
7lnroatioflrtr4e10 °"
y�� Dvd, �_i re* l,�,,�
Print or T Name_ Print ! 111h
, �"0 �
rI t ,i e i rrt qr Type
LsJ7SStJ 1,� 3�s r 7
City r•. t r 4186 i1•Lo-�-•
g11r 11 -6.0/ i ►12y3 ��y
Tele p�Number/email address
r�JJ Te/eph ne Number)email address
f 8"!113/x*1)
Date Date*
`Valid for one calendar year after signature' (Revised Aug. 2014)
a

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to ee-\);ie. 6.\)5 1,-) ,s
;Name of Property Owner)
:roperty located at ] 1 &VA ') Cilf h A- 1-4,)i( g-P
(Address, Lot, Bloc , Road, etc.)
qn 3.0 r 6)0,4 qe-E-t._ , in c3EL ..JE IsJ , 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)
,t,t'•
: Or
(t.
/
v ,s
v
) /)
t_.-
4. ,,,:
i
.e44<-
4-...-; __
A
, 1
...,
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.A
1-0 , do wish to waive the 15' setback reauirement.
I do not wish to waive the 15' setback requirement.
(Pro orty Owner Information) (Adjacent Prope Owner Information)
*4-01
Signature SOantrel.
Ai
, 4-04 6vi )
Print or Type Name
/MY TtectyNne T r Ch)Cd a i'ri,li Ak, anq
Mailing Address Address Mailing Address
1+1 C 21 WY
‘,..(1y/S -1Zip
City/State/Zip
grq- 012-000 f ‘2,5 a- pt-Q07
Telephop e Number/email address Telephone Number!email address
fl.`112-0
13 17 14)11)
Date
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

A uth orized Agent Consent Agreement
1, 40 AI g"f ,herby authorize Tobin Jay Tetterton of
(Property Owner(s))
TJ's Marine Construction,LLC to act on my behalf in obtaining CAMA permits for
the location listed below,
PROPERTY ADDRESS:
/17 IAfv1e s 61 fte. Loa ? QJ
fcikauEts NC. Z'1 Y1p
PROPERTY OWNER'S MAILING ADDRESS:
&U CP 61;W 54 .
PAlt 11 Oc_ 276nf
/�
Phone No, I -t a ` CO) 2—000
PROPERTY OWNER'S SIGNAT
URE:
AUTHORIZED AGENT SIGNATURE: ��
�yW`'70111M11
TOBIN TETTERTON
DATE: p " 20 20
W/Anthaiud Agent Consent Agree.
4

NC Division of Coastal Mgt, Habitat Impact Computer S1 ee~t
Applicant: 4,,,k rl` 1
Date: /2 yeiz0
General Permit#: 7 7__1,r(
Describe below the HABITAT disturbances for the application. All values should match he are,and units of measurement
found in your Habitat code sheet.
TOTAL Sq.Ft FINAL Sq. Ft. ' TOTAL Feet FINAL Feet
(Applied for. (Anticipatedfieal (Applied for. (Anticipated anal li
DISTURB TYPE Disturbance total disturbance Disturbance c disturbance.
Habitat Name Choose One l includes any Excludes in total includes Excludes any i
anticipated restoration any anticipated I restoration and/or
restoration or and/or em p j restoration or temp impact
temp impacts) impact amount) temp impacts) I amount)
© /�_!ie-n ` a' Dredge❑ Fill❑ Both ❑ Other 2/I / f /b f
Dredge❑ Fill❑ Both ❑ Other 0
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both El Other ❑
Dredge El Fill❑ Both ❑ Other 0 !
Dredge 0 Fill❑ Both ❑ Other ❑ I
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑ I
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑ IIIIIIIIIIIIIIIIIIIIIIIIIIII
Dredge❑ Fill❑ Both ❑ Other ❑
i
Dredge❑ Ft 0 Both ❑ Other ❑ IIIIMIIIIIIIII I
Dredge❑ Fill❑ Both ❑ Other ❑ l aIIIIIIIIII
Dredge❑ Fill❑ Both ❑ Other ❑ 1111111111111111111111111 .