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wi CAMA / 9DREDGE & FILL J Yc No. 6 ' 86 A B CID
GENERAL 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 07 1:1 . %Qe
nn , Rules at ached.
Applicant Name � �{' / y l I 110's Project Location: County_ X P F
Address 1g05 \ MO&YF_ L n Street Address/ State Road/ Lot #(s)
City GState ZIP47&1-3
Phone # (n) ce-`7P E-Marl , / Subdivision /Sea �� e-
(
Authorized Agent "f Qj VV ea` e-(, City (`� ZIP �� ���
Affected ❑ CW 'k-EW �tFTA ❑ ES ❑ PTS Phone # ( ) cRiver Basin ��HE 04
AEC(s): ❑ OEA ❑ HHF ElIH ❑ UBA El N/A Adj. Wtr. Body vO 0/man unkn
❑ PWS:
ORW: yes /� PNA yes /i Closest Maj. Wtr. Body O e- So
Type of Project/ Activity ff a0c F °d Ad a—F8 h S;
Pier (dock) length
r
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
Bulkhe fRipra ngth_
avg ist.nce offshore_
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift r
Beach Bulldozing
Other i
i I
Shoreline Length _
SAV: not sure yes no--
C;C s
Moratorium: n/a yes o L—
Photos: yes
i
Waiver Attached: no D l
A building permit mayberequired by: 2/
( Note Local Planning jurisdiction)
Notes/ Special Conditions P� O t7 S / © C
L ex [- WeA vex
ge or Applicant Printed Name
Signature ** Please read compliance statement on back of p%err'miitt
tio.
ApplicatiFee(s) Check #
(Scale: i )
❑ See note on back regarding River Basin rules.
w;4� ; n /'!�- " o-�-
PermitOffi tint Name
Signa re
i
r
Iss ing D to E irati 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: [phone] Fax: [phone]
(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: [phone]
(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: [phone]
(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit i ) �, I / 1� I V Vl ► V 1 �P _..S
Mailing Address:
Phone Number:
Email Address:
1 (� I' aA- iA_? C
1' 1 i 1
IP[� ��i•_Pr rli 1Y1ir S ��ll `,f1)!�I I, �(��1�
I certify that I have authorized ; Q I oN W . P� Vt-✓
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: i1 j /i
at my property located at a D S-P ck
in CP- 44---k-T' County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
I 4 ✓ t ti-I 1 k�-C' S_
Print or Type Name
Title
hp
Date
This certification is valid through I % � I -J
ul�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to fl4 ,,,- _k t Vl �` - vLt -S 's
(Name of Property Owner)
property located at �c �' �`' f- �- `: �( (� �-
on ��> ,�� ,�7�_� �d (Address, Lot, BIQck, Roa , etc,)
in `I 1[I.�Gt a l y� / U✓ '_)) 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 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)
JLit,1 �(r.� err, YJ�a✓;.��') 5 c l/ (,y 3 E '-�
r'
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.
(Property Owner Information)
' � .P h. � �.,1 ✓ Irn I K � C S
print or Type Name
1.-. _ -, , "- 1,,.
Tel nu
S lNl ,..n tciu
1 r"
Number/email address Q ��► �� Telephone Number/email address
Alit,*
-Valid for one calendar year after signature'
'7e5-12-
(Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
'V� Vi'1 's
I hereby certify that I own property adjacent to �-.Q A��u ✓ r-1 G� � i ,�-(( _._.-
�e�- J dName of Property Owner)
property located at _.mod �-� �� I p 1
J (Address, Lot, Block, Rgpd, )
an I G�,�� � �%1�G , In �„ IINAt n (�i (_n_ / 'art �e f , N.C.
W terbody) (City/Town andlor 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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individc:al proposing development mast PYY In description below or affach a site drawing)
{IUII�� J-16t`II;IV 1)1G\1��� jl�' w���� G'V��t✓_,
J
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.
(Property Owner Information) (Ad acepJ Pro e w er Informa ikon),
SER LO rl- 7�io�V a -! k
St aal ure St lure* Yf T
Print or Type Name Print or Type Name O.7
FI 05 C r, IMcc r O r r1 C�f1 �'H �T t.K-,4b.J .b 6113o s P dr lgD X 1 9
iiinp Add ss JAI i1i g Address �—
a N L �� 7 I 4V 5 "I
tate U' (� city/State/Zip
al D,CUBDD�Y
/ 7tT�—%7hT
7'ql phone Number/ e� ail address a epho a Nu em to i ber / address Q ©.41
tj up,
Date -gad*
(Revised Aug. 2014)
"Valid for one calendar year after signature"

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t, r, • t bar+ ry 4\r V- I s
(Name of Propertx Owner!
property located at 'ECG `- ,t , p (- I , , A I ,. - r
(Address, Lot, lock, Road, et L
on ``)t t ( e) N C
(Waterbody) (City/town-and/or County)
The applicant has described to me, as shown below. the development proposed at the above
locati
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 i v a �, c'r' t l �u- /•Y? a
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.)
1 + r I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Pr rty Owner Information) ( djacent Property Ow er Information)
i
Por Type Name r+nt T pe Name
„_ i
W3
crtylbrareluN $
•7S/
Telephone Num er I ernad address � grVK,I.
%..J Con,
'Valid for one calendar year after signature'
Marling Addr s
city/State +p
Teleph ne Number / emad address
(Revised Aug 2014)

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