Fortier, Mark 76781C

4CAMA / DREDGE & FILL () 76781D
GENERAL PERMIT Previous permit #
�.P r:
�'Alew 1--Modification Complete Reissue Partial Reissue Date previous permit issued____,_._._—
As authorized by the State of North Carofna. Department of Environmental Qualdy
and the Coastal Resources Commission in an area of environmental concern pursuant to f SA NCAC
11 xP.ues arx�
AAPlicant Name _ Nlc� OC"i .l Pi\ _. Project Location: County Xl
+ r j I r-t ece-----.--
Address (� ./_ Yn L)pp_� 0 C-1. �'e .- Street Address) State Road/ Lot #(s)
City ..�l n ('!._lln011_v Oi ("St3te9Ce zlPg'5/a
Phone # qi9) � JQ ^5_73 _ Subdivision
(i 11,~ E-Mail ---- _ .
Authorized Agent �Te.CC-! icj GP, - City_ zip-. -f
Affected C�+/ XEw i{�TA :ES PTS Phone # (. ) / _... {fiver Basin ��/j t/�L�(•\
AEC(s): �OEA : HHF tAH .UIIA LMA Adj, Wtr. Body
_Q S L c11O J
PWS
ORW: )ess no PNA yes ! f Closest Maj. Wtr. Body-.---
Type of Project/ Activity 1 n ci[' 11 T
It �
FL.ed Pla:fam(s)-
___ P
Roaong Platforms)
Fm e .
G.am te'rh
Bu'kh"d' Rpop length.._^w
arg dnurKe onshore`_._ i. I I .. ..-..
r*m d,sine efishve_._•____ - %�_
i
cubic yards.
b�tJ -,---
Basin,
r _
Baas ramp __ /_._ _ -------
— -.
I SX131
Banhrus Goad h - i I i
Beach Bo;Wor ng ______
may_ not awe Yes
Mo tonum-. n/a Yn
Photos:
yia, er Attached69
C
A budd,n8 permit may be required by: �� r7 � `> [J Soo note on back regarding Riv c1 Bssm n.'n.
( Note Local Planning Jurisdiction) 11• �,I -% J )
Not s/ peci Condit) s // tt:.:.,-.i.
'N pl/rr e
-
-- -
ntorYrvil At.n,e -- Permit0llcer'sRvuN[la'Ali/� �// 1
SwA�n�>ai.ucns2te.0mf0•ec•j.q � .. _. 'tA_t"nePirate rca /nat
7737Isng /DYo. oU(4/ ` �J O
i

AMA / ❑ DREDGE & FILL N9 76781 A B (D D
GENERAL PERMIT Previous permit#
;110�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 I SA NCAC
/� (Rules attarJted.
Applicant Name y'K Fo 1 e,5� Project Location: County
Address 15/ .L© /l/ y D f 1ye, Street Address/ State Road/ Lot #(s) -- 1X4'A
City—h
ZIP
Phone # (J!'1 ).� E-Mail
Authorized Agent eSXCY VC'I C-e-
Affected ❑ cW �W �rA [I ES ❑ Prs
A
Affecte 0 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWs:
ORW: yes (V PNA yes /
v
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no i F_i
Photos: yes n
Waiver Attached: es no
A building permit may be required by: 0 vJ
( Note Local Planning Jurisdiction) A f L I
tWnt or ppp rt Printed I)lame
Signature ** Please read compliance statement on back of permit**
2737
Application Fee(s) Check #
Subdivision
City / ZIP
Phone # River Basin
Adj. Wtr. Body r&A net m nkn
Closest Mal. Wtr. Body Uke
❑ See note on back regarding River Basin rules.
1 1 i. — n t

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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑Tar- Pamlico River Basin Buffer Rules El 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
N 1 i I hereby certify that i own property adjacent to k Iry i r- s
property located at
(Address, Lot, Block, Road, etc.)
on , in f1 .j I n) t L'u 4 , N C.
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
local op%
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)
k C U U 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: (Ifnyou 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 Informa ion
.Shi orulnre 11
1�rIC
Prinl or Type Name
Ma hng Address t d
Cif /slate/Zrp
�11��1k 33 3 3
Telephone Number / email address
sure
'Valid for one calendar year after signature'
(AdjoaLccent Pro ertyO e�r Inf"o��111atio )
Signunrre*
Print oyj'p5'N
Mai6meA� Zl 7
nJ/ld✓
��C+ty/state/Zi
Telephone Number / email address
I,,,�i. *
(Revised Aug 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: M(Ar
Mailing Address:
A-1)6V1
Phone Number: 9 1 q- 111 K— r� } 3 3
Email Address: �tn��r�i°� misfl��ne •(u�/
I certify that I have authorized ly PC t u P 4LVsw
^! 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: f h 54, ) / r) ", ! k
at my property located at %5 I lnS )n )14-y )9ir,c-c. �; 144%"�-Ai_ kA
in C(, ,,LJ County.
I 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:
rgnatu f,
Gr)< r6/).,—
Print or Type Name
0 )'-� (\�
Title
Date
This certification is valid through (i I / :? 1 9 ✓],;) I
RECEIVED
JUL 0 7 2020
DCM-MHD CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: m(Ar k For Al o
Mailing Address: % j ) l o4, ,)
A116n�,c 13P�c1\I l�L abs�2
Phone Number: G) ► 9- fS 2 3 3 3
Email Address: �ltnf ier rnj:n
tr(prIe, •(uW"
I certify that I have authorized l p+2y P(1 G< 13,P � uCV sw
�T Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: In 54, ) / n"' `)R
at my property located at % 5 ) n5 )n )t r. t '44 )4,4? 'v!
in CG,.ln �} County.
1 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:
p-� Signatu
Print or Type Name
Title
Dale
This certification is valid through (/ I / �) I 9 0'�
tw'
RECEIVED
JUL 07 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Ir, , K j w i r e- Is
(Name of Property Ow/p�er)
property located at 5 / Z �i /1 Le �)�/; � :4,
(Address Lot, Block, Road, etc.)
on , in ft -1 1, 11, � 1,1,e, 4 N C.
(Waterbody) (CityrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
I have no objection to this proposal
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
V, r
ik
rx
C0 IJ v
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
Si nrtue r_ 11
•r r�ryi��
Print or Type Name
/ S 1 1" to )t_-, 1),
Ma /rng Address
AEI 14 r �.'„I,
Cd /S1aler'Zrp
�l('1 �14s' ,)333
Telephone Number/email address
[,-),)-von
Dare
'Valid for one calendar year after signature'
(Adjacent Property Owner
Print or Type'Name
I3 t-c'-M 11\( nr.
Martino Address
�ir_5 r k)
Cify/Sfate/Zrp
ZSZ- -773—o'39it
Telephone Number/email address
-(G- Zozc'>
Dale*
(Revised Aug 2014)