Hagy, William 76605C

"G�NtiAMA J DREDGE &FILL N9 76605 A B 0 D
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partlal Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 't
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 0.7 ^ C0
,, I � I /+� ales attached.
Applicant Name W Project Location: County l C'01 V
Address ` Street Address/ State Road/ Lot #(s)
City ( State ZIP
Phone # (7S) S
QQas 7- E-Mail Subdivision.
/n�
Authorized Agent V SP VLISP ` , 19nc,-F— City— n ZIPS
Affected 0Cw "�S 0PTs' Phone # (_) River /vat 0G
AEC(s): oOEA EJHHF IJIH ❑UBA ❑N/A Adj. Wtr. Body /_llt<' AfOrnan un n
❑ PWS:
ORW: yes / o PNA yesi Closest Maj. Wtr. Body
Type of Project/ Activity V cc
(Seale: -1 w
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A building permit may be required' by.
( Note Local Planning jurisdictionh
Notes/ Special Conditions (
I f /1 r rTfy
PermltOfilcer's
fSSee note on back regarding River Basin rules.
•*PleSOead com lance statementon backof permit'°• Signature
�3�$7 .57- 911aA9.0
ee(s) Check# Iss ng 'Ye xpiraonDate

) CAMA / XDREDGE & FILL J W 76605 A B c' D
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�1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC D7T! • II©O
IA I
Applicant Name VV f I I I An l -4,A U Project Location: County ccA=ttached.
Address 49S ��(_ K �y - — Street Address/ State Road/ Lot #(s) ( /` (
City (! 1 1 P' State V A ZIP
Phone # (jV4;,)_5b
Authorized Agent 6
Affected Cw
AEC(s): OEA
❑ PWS
��yyt
TA S ❑ PTS
A
❑ 1-11-11 LJ IH ❑ UBA ❑ N/A
ORW: yes �0 PNA yeso
Type of Project/ Activity Onnp�
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
a
Finger piers)
Groin length
Bulkhead/ 'prap length
avg distance offsh<
max distance offsh
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boadift
Beach Bulldozing
Other
Shoreline Length 10�_
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Special Conditions TVA
&C 4 SAc©15112,
r Applicant Trinted Nalne
nature ** Please read compliance statementon backof permit"'*
L� O
pplication Fee(s) Check #
Subdivision
City—jo�IP��n ZIP Phone # (_) River Basin / V^/
eiSe—
Adj. Wtr. Body — o a an Junkn
Closest Mal. Wr R d .� i(®
(Scale:
D!�See note on back regarding River Basin rules.
R%J Go /
Permit Officer's Printed ame
Signat e
2% -- 9/i �lao
Iss ingD a Expira on 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
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:
Mailing Address: 1.2—
Zec4v,t1�
Phone Number:
Email Address:
I certify that I have authorized
G(X ct(-Or . Cows
r0JS�'- 1�r
I Contractor
J1iCV— (Q"nJrj<
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in ryyvW 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 evaluafin � rLreI ted to this
permit application.
Property Owner Information:
Signature
L i C<v.1 1-A . \�
Print or Type Name
Title
Date
This certification is valid through /
DECEIVED
MAY 0 8 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LU i WM'�% 141�k c, -( 4 Soso,', Q- wt,1,
(Narpa of Property Owner)
property located at V3's broad C ICI" . 7
(Address, Lot, Block, Road, etc.)
on Ne�Se V-�str ,in 2w 13e'r 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)
'P�ouS\N\ -7D oiF \/i q b�\khe�•c�'t� 1 Fwee�l
1`%Yle5 o� Lai 13 a'\d
IY] 13r0actv ie-w 0�-, -1-�-c N2u5e, ver
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 waivI��D
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. MAY O 8 ZOZO
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adja nt Property Owner
or Type Name
22
C1 r.
�173"32 f—b�3� 5a%ID 5(zPgril,'. 3rna,
Telephone Num er/email address
I2�_lto IA
Date
Print or_y-
T
M 71 g Ad
City/State/
?/4-i �1
Telephone
Date*
DCM-MHD CITY
© qMI?%Coko
*Valid for one calendar year after signature*
(Revised Aug. 2014)

1. . . � !, 1,
I I.i I �vr

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i 11'.4 w' A S
(Name of roperty Owner)
property located at 3 d rope\ C--e-e,k V-a .
(Address, Lot, Block, Road, etc.)
on AAe-\is . Y'�vet in New %erv\ 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.
DESCR!PT!ON ANWOR DIgAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
VOv501 Ia, O�7
1 �n �UY0naV-Iew o"-N
Vit,Y� bo\kinecC)'In5 be4wee vl
1.a} Sczv\dWA oFl,�-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.) DECEIVED
I do wish to waive the 15' setback requirement.
�do not wish to waive the 15' setback requirement.
MAY 0 S 2020
-MHD CITY
(Property O ner Information) (A 'cent Property Own r Information)
Sign[\t tu�r�e 1 \ Sia%;�Ujle
Print or Type Name Print or Type�me
��Z S`eas ?&,-,4 cr. N^`IMY,,Ac,4. .4 ut
Mailing Addre s Mai i g Addrars
R eed v l e . Va . Z 2 S 3Ct M uJ 1J)" /l%C Z8S6 -z
City/Stste/Zip City/StatelZip ^�
'-1D3-32y-613`I SC6li0n52Fari �. nv;k�_ o7So�437-Re/3 bo" ca;'�J t 1vdt
Telephone Numb r/email address Teleph ne %umber/email address
121 \b�\0\ �ate�`�
Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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