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L PERMIT Previous permit
a �fcGv ?Mtadification # %Complete Reissue. .!Partial Reissue Date prr�viot�s IaertrtEt ssi}eti
As authorized by the State: of Marti? CsrOna, Departmerst of Quality
,and the Coastal Resources G:ammisslart in, an area of ervironsnentai concent pursuant to I SA htCAC
Applicant *lame ' ' f Project Location! County �f �� t�->���i x!
StretPt1�dcftess/Stara goad/ ,rat (s) ;`�9 1'1�i
Address_.
Clay irk,State
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PWS
Closest Maj. Wtr, #;^dy ..
0RW,- yQs nO i PNA yes r (E" )
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` CAMA / ❑ DREDGE & FILL No. 76382 A B Qc D
G N E RAL PERMIT Previous permit #
ew ❑Modification ❑Complete 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 15A NCAC o Zf�
-1 /
Rules attached.
Applicant Names �! ��CM � Project Location: County_ allow
Address 1000 V, V Street Address/ State Road/ Lot #(s) Q
Ci!1 r State, CZIP
Phone # () g ✓ E-Mail Subdivision
Authorized Agent City
.lS2�% ZIP
Affected ❑ CW -EW �A �S ❑ PTS Phone # ( ) River Basin j ►'�
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body
n man unkn
❑ PWS:
ORW: yes no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity 12
Pier (dock) length
Fixed Platform(s) 74
7C
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length i
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat
Beach B Ildozin
1 -
Other ! -
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes n
Photos: yes
Waiver Attached: yes n
A building permit may be required by:
( Note Local Planning Jurisdiction),
Notes/ Special Conditions, '02
VV
Agent o ppli t Printed ame
Sig ature ** Phase read compliance statement on back of permit"
oo. -- - - 4�_�33
Application Fee(s) Check #
MOO
(Scale: )
❑ See note on back regarding River Basin rules.
A E C 011/'I e, lI
Permit Officer's Printed Name 1-11
Signat re
g
Iss ing to xpir tion 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 1) 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/ 1-888-4RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender 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 3,z�ey (A I rJo. aoR V►nel.rj 's iJ3
I_ ` (Name of Property Owner)✓
property located at gp1 C rl 4 kcore 5 d r^
(Address, Lot, Block, Ro d, etc.)
on 6t-o c a- . in Si�11 Ara 5 bNs toc 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)
Cam'
r
u
,L
1,
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.
P Owner Information)
Signcatit
Print or Type Nape / �
(ova - 2-
Mailing Address
_�)J N,
City/State/Zrp
C)t°' sit- Vls�z
Telephone lyurn4er
40 o
Date
(Adjacent Property Owner Information)
Sig ature
s se4 j -5. c 1-1141 -;--n
Print or Type Nape
e W
9
APR 15 2020
(Revise 611812012)
6CM-MHD CITY
� 1.
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �or.M '. A4NA �d aRmA�1 s
(Name of Property Owner
property located at Cwl C�naaw ��lc Stnoas� ttt. 5r4'eAL4c
(Address, Lot, Block, Road. etc.)
on6((Wa C /Zek, e- 'in- Ne A�5 O n! S (a w 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)
_ Q 0kz
00
f
JAIVER 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.
rm
ci nuru J -CI-4�b1ZWa1-J
Print or Type Namd
ine,
Maili Address
� (( �� v 7
IJ.*J N� C, c� J 3 V
City/Staip �C
c, yq ! � S y
Telephone N mbe --r
A41��90"0
Dare
t Pr9perty Owner Information)
Print or Type Name
Mailing Address
City/State/Zip
, 93 % Z, -3 7C.J
Telephone Number
RECEIVED
Duce
(RevisecAPIR81?51 Uz0
DCM-mw CITY
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ajoldwoo jol'.IOAOMC)q 'ODIOAUI ajoiqaA junpe 04 JGJOJ Gse@ld 'Gle,11"Me A.IPI.uwf)S SILIJ L11 pap!Ao-id 1.101113LUJOIL11 13LIioijd ay; @New ol pats; seq A-
fUOIUOAUI S,JOUVed 6uipejj_ of sBuolaq 813140A S911231PILli —
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RECEIVED
APR 15 2020
DCM-MHD CITY
F E'a"an- S "al, i.1 t e— O!M! Sh,lich", — Plibli, Int", Sho"Imu—— ("be, t
—
oTHER PERNIVISNIAN'HERE.Q11RED: I '111a k. p-mr., ndrer than the CANfA
minor dcrele;nnent Permit, indu;lim .hat not ittl w. 111)l jJag Wawi- Well. Septic Tank icl: ether sa.lam waste
ii-t—It Ysienaj� fillikang. Fl,,n will, fician" :.nd An Ciindallaliiig. ll—Utwo 111all Eal-gY Clole—liiill- HA
WN1,11
od-,. (11-1, ME], your L-A P—uit officer il a ..... , int"roialwo.
GFNFRAJ. )INFORMA11ON
LAND OWNER - MA11,1N, RESS
JcaJA A . . ... . ..... ............
locc, -eaag-
Zian3 ipoml,
%c.TllORJ' 'D AGENT
1-aill
.... ...... .... .
ity . ...... . zip'-- Ilimle . ........
LOCAIJON OF PROJEUI: (Add—,, 't—, man and/1" (fi—uon' to 'ite; n; e w-llwad!—Imi —teftdyj
.... . ... . ..............
fil 101p I TON OF ROJECT: (I It p oI—ed—i.01111m, ind Lore d,stluba;,—)
,11T. OF I -OTlPAR El, i4ila" teet
ilROPOSI'D USE; k,%k1,.;,i1;! iK- r-) MI'd?; I.lml;y L) ) I 1.d vilki'vild D Oil!" Lj
CONT T-ETE EITHER (1) OR (2) BELOW (C-1-1y.- L."d Pe —if Officer if),. 'rhi'l, lFc.1,10"
11) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTUFRE: squz:', r `1111 1-lad",
li ;aLz space, parking ei ... tell above ground level, inn -con litinncd q--e elmited about ,, Uad el but
afli, sp,—)
') COASTAL SUORELINE AEC,: SIZE OF BUILDING FOO-1 PR HAND 01 HER IMPERVIQUis OR IC-11 I
,-j PON SURFACES squire all n—
illa, Id, .. ma'( vparrs, ew thatarethe appli,iii1ill, Al:(. Attaen yam caleula;ma, —11, the pan ea dra,iag)
i1rXIE. S I ORNIAVATERM ANAL E* NIF.NI'P ERNI Y['- Is the proulet 1-aledin anarca sulli-tit ll j.Naae
Nla,mg--ul P,loit i—i,d by the Nf: Dil-�,,n of Mme,fl and Lwai R--lcc, (DPM!Y)'
YI I NO We
STAMMENT OF OWNERSHIP:
I diland—igoed, a. applicant I., a LAMA tom, d ... Ilipaicat nerve eaher the owner A properly it -a AEC11
alitlanind to act a, a,, ag,ila fill J—la's,sufapplying, fur CANIAminia dmelopulcul pe:n it. ccru&y that the pr-a
hst,, 1-d.-- oil ti- appl—lioll ha., a —11;zlcai, iat,,eq In tile ,ill p,,,j--,yd,s,,ibed thia-eiii. I hisuil—,t b,-
dennbed as. (lhe,k.,n,!
14the
\ I . A -O'l�
l Air
Deed ,mic 5 05 Page '7'F Z -5-1 at the0 C,a R"-uy .1, Deeds.
Appli'mit is as I"i, t" th" dr, ------
bat,wa, in . .... .. .. County.
if ,,lima nu,re,t..arch ns written contract or terse, ssiein bdmv ar use a separate she,& � attach m fL•is appliculion.
NO'TI E1C.V1'lON OFADJACEN'r RIPARIAN PROPER1 Y OWNERS:
I fiamm thi-il, 1:dll.,iag pm."nis we urine,, of properties a. djoining this p.,p;iry. I Abin, that I have giecn
ACT UAL NOTICE to each of them 1.11—liag toy i,ali.L t. develop this pop,,Iy ,ad to apply f., it CAMA pia-rait.
'N (Addire"
cl,)Lj,c Ic
(2.
(31 1 . .. .....
t4l
ACK-NOWLEDGEAWNTS:
be lai—p; iblc 'Oo a,:.,, aid el 1—diag. I ,kno,% Use (hm [h, 11lcr'111- OJ-11cci !!a, "splai—I ,, Bil rill PM il:U-
1"I'aacli"i"
llernaa—eltily;bai i*llu gant, pernas,;wo to Di-,i- ofCommid Nfilo.,,,a—at mslE
ih, Local Permit 011i— and their',,coats to late, un da,aiiae—ilai-ed hinds i. eii-letion with e,ahwitig int 11.11
to this p-laiv aplill"au.n.
r -1*1 '1z
This
the day oAf�4\. 20.
. ........ .... . ... ...... . ... . . .
1-11--or oha- a CAMA peo,w appli—M)"
i "aa.
This qpplkali- n"I I'll: g of mh,;;? .......... th,• ha.4-1 ihi.—ppliodnn• din
;hc 0—;', Ila--fAr.c vofi 1".
'irl,:ii�,.jj-j, , C,ft' , m"ll, is th, h—lil, "ad
h, "'n idug r A h. !j1-1lilfi fl—hwih oft "It"licanoa fib'd h-11111, lie
it,! i, "i—,— ma?n h . .....t be is,— k Ov% h,,,, is— di-ed . ..... �, " W - we , vwifafi- ,,l
....... la"".4"piRgma, i and adaumis,,ain! at I
RECEIVED
APR 15 2020
DCM-MHD cry
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