Rackley, Frank 76792C

1.
YCAMA /DREDGE &FILL NI? 76192 A B �C D
GENERAL PERMIT Previous permit #
j Nevi Modification Complete Reissue Partial Reissue Date previous permit issued_______ _
Au mn' o, zed 0, the State of North Ca,o ,na. Department of Environmental Quality /{/�•s7
an:; thr• Cws:a� Resources Comoutne , an area of environmental concern pw:"arrt to I SA hICAC_ ._O ��L r �t_+ -- -- —
_ Rules attached
Applicant Name trl. � 'f�.Y Project Location County CZ
I
Address CI
Street Address, State Road' Lot #(S) �j-Vi/✓V.�i .
City ile��' CIA state I,/( ZIP
- Subdivision
Phone OrL-r_Nl,.•• , - �._ E-Mail _
Authorized Agent I r.^ C�• t'". l"+1'^t'-' City ZIP
cw -/-ew PTA i tS PTS Phone # f ) r Basin
Affected OEA HHF IH UBA N A mars ,
AECIs): Adj. Wtr. Body "'�(% J 4ys s ^C 9
Pws I �
now .o. /qe PNA ,rot '.iti Closest Maj. Wtr. Body"-VVl i i i C '-ter•
Type of Project Activity
i
5:a• . e...;.
5onti.ovsc &,aCAr
/r.t .•.i /.t•1[i Cif ��/ "+
r cared U
A oudU n:g permit may be rc 7 Y
!Jot, Loral Planning f,.rrsd.cuor, r r
t
Notes: special, Conditions �_ �.=1;�A1.y \
}� an
hear.ttnt,n„r. Sul twnnmrnntY••'
ln)Wn
/�
(Scale: I � / )
� 1,
1< See note on back regarding Rver Basin rues
n1 11 F
Qc -_ Al / 11 n e 7 /
Pcrmn Olfwer's Panted idanm
Signat re
Iss.I•P. U.t 1
/ .r
E .p.r,4:nn Date

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CAMA / NI"DREDGE & FILL N9 76792 A B (D D
NERAL 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 f
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC o
Rules attached.
Applicant Name �_� (�( kteY Project Location: County 6zoyen
Address
I WWRIlii7iw,
S� �/
Authorized Agent__.emu ciXtIotnus
Affected 71CW ..+EW -U PTA -RIS ❑PTS
AEC(s): OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /® PNA yes /®
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
avg distance offshore'
max distance offshore 1 n
Basin, channel I
cubic yards
i
Boat ramp
Boathouse/ Boatlift
Beach
Other
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes
Photos: yes,
Waiver Attached:
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Special Conditions
id f - � .
Street Address/ State Road/ Lot #(s)�
Subdivision
City ZIP
Phone # O er Basin S
Adj. Wtr. Body S n man unkn
Closest Maj. Wtr. Body v
(Scale: / // ©f )
ASee note on back regarding River Basin rules.
s Ev
C
ted Name PermitOfficer's Printed aread compliance statement on back of ermit** Signat re
-f _ %97o2 �li�l2o©/��/
Application Fee(s) Check# Iss ng DaExpiraflon 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 isinspected 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 th is 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(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: E�&,,iA�pekl `r
Mailing Address: /C) 1
e J 'E J 1� ,.) n) C_ �a�o
Phone Number:
Email Address: /= T R 4 CK t a
I certify that I have authorized _jom GglZr haul Tj L
tor
S/11- 188�— TGGvRGA,v�s 7.il6Al�cWVn"'- •Go!n
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Bitae& 6glw*7� 0.✓
at my property located at arm I ilT O A REej AC
in C0 County.
I furthermore certify that I 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:
r I11/l VI I yN6 IVOI I IC
D �J /-) _�;�
Title
Date
This certification is valid through 7 1 Y / 101d
RECEIVED
JUN 10 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property_ adjacent to J� KA') lC KA c K U&-I 's
(Name of Property Owner)
property located at I�J t 7'D a Lt� �
(Address gqc Lot Blk Road >p etc.) I
on A9U. J.ZA , in njF< Wl ,l JC/, �J Co4,J 7 N.C.
(Waterbody) (Cityrro n and/or County) T
The applicant has described to me, as shown below, the development proposed at the above
location
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
I L,Act` Gk�,�2 � Z _7� f=/Qo.) o i= e,/%M A,4,Lr Sp- A ,J A L I.
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.)
Date
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
a dl. a Ili f
Signature n I
l>rl1h'� �'r1\ai t
Print or Type Name
too L/ c9c A-a'N L'
Mailing Address
it)t w ncr,t)
CitylstatelZip
Telephone Numberl email address RECEIVED
3- y - 2 01D
Date*
(Revised Aug. 20 )Y)N 10 2020
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � !\ 94 C rrX LF- % 's
(Name of F5rtY property located at / D UZ,0 A LJ} )oPno nao�S(o0
(Address, Lot, Block, Road, et .)
on aP6_ krjc �• in n eq3rFif-n 1"J : `7 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat'n.
Y r 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 orattach a site drawing)
l.Ao� 42A,41-.'E_. 2 _'a 1-2a J o i= Cis. A t,tr S1-9 A�J A L 4--
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.
C K, Z 7_z7 1/7?I /
Telephone Number/email address
Date
(Adjacent Property Ow r Information)
zel � ,
Signa ur/1f.4
Print oro l✓ Typg Na—
v
Mail' Add s
C. 2dJb7
City/State/Zlp
�sz 6/2"'90-z 4.,A0V +e//i9s6
Telephone Number/email address
3-/o-z o
a5mg"l..co.,,
Date* RECEIVED
(Revised Aug. 2014)
'Valid for one calendar year after signature' JUN 10 2020
DCM-MHD CITY