Sherman, Williams 76624C

AMA / O DREDGE & FILL N4 76624 A B D
L�JbENERAL PERMIT Previous permit# CC
aw 011odification ❑Complete Reissue OPartial Reissue Date previous permit issued
As authori d by the State of North Carolina, Department of Environmental Quality F{ i.! 0/ (�
and the Coastal Resources mmi io in an area of an nmental concern pursuant to I SA NCAC /// ��/ og
��❑ `des attached.
Applicant Name t Gam\P /` Project Location: County,_�,�� tl
Address Cc'/ Ah Street Addresss//State RoaAlLot #(s) ^
City_ _ L Jcv, ^J y State�ZlP�_% (� lA
Phone # (/-W / j J '1v1 Ef- Mail
Authorized Agent
Affected DCW -f�LO i?KA
AEC(s); ❑OEA ❑HHF ❑IH
❑ PWS: �
ORW: yes / no / PNA / ye no
Type of Project/ Activity
Pier (dock) length_
Fined Platform(s)
Floating Pladomn(s) _
Finger pier(s)
Groin length
number
Bulkhead/ PJprap length
avg distance offshc
max distance offsh
Basin, channel_
cubic yards
Boat ramp
Boathous Boadif
Beach Bulldozing
Other
Shoreline length
SAV: not sure
yes
Moratorium: Va
yes
Photos:
yes
Waiver Attached:
yes
no
Subdivision
C city I,) C%r^/ d ZIP
DES OPTS Phone# (_) River Basin
❑ URA ❑ WA Adj. Wtr. Body I A CP man un
Closest Maj. W[r. Body U� r
(Scale: JAL -of )
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110-■
Wall!
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ii
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1111141MI
as
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Cfgnditions _
e
i
(� ✓ ❑ See note on back regarding River Basin rules.

iN1-1 AMA / DREDGE & FILL N9 76624A B vC D
ENERAL PERMIT Previous permit#odification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality `� /� "'N /'i /
and the Coastal Resources ommissio in an area of en ' nmental concern pursuant to I SA NCAC / / O V
6 �,,❑ les attached.
Applicant Name_ I �tT O\ h_ _ PST Project Location: Countyo /I(
State
Phone#(/lam) /)l 'ILJ EfMail
&�--Z U e-
Authorized Agent
C
❑cW
-E;a ,E-P A ❑ES ❑PTS
Affected
AEC(s): ❑ OEA
❑ HHF ,J IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no
PNA (ye's l no
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ ftiprap length
avg distance offshc
max distance offsh
Basin, channel
cubic yards
Boat ramp
Boathous Boatli( X 1
Beach Bulldozing
Other
Shoreline Length , »V I yam/f
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/ Speci4l C;gnditions
t
Agent or Applicant Printed Name
t
Street Address/ State RoaALot #(s)
i 7 ?
Subdivision _ (
City �hl C t^/ ZIP 2
Phone # ( ) River Basin ,!,N
Adj. Wtr. Body U - i A CY n man unkn
Closest Mal. Wtr. Body Ua r
(Scale: AJ'11 )
U:', ❑ See note on back regarding River
,/ ,.J/`dam skn-j cr
Sig �`* Please read compliance statement on back of rmit**
ication Fee(s) Check #
rules.

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 ❑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
252-808-2808/1-888-4RCOAST
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
% ✓ i
Name of Property Owner Requesting Permit: , ir� J/t 6��I/`-
Mailing Address: I / / 41jea (, iya /<Q/
/Zx�Yi��ooro
Phone Number.
Email Address: i (4a PID-a
I certify that I have authorized ~ V /Gzc �O
Agent/ ntractor
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 I
in nCounty.
L
l furthermore certify that / 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 aforem
plic4 rrt lands in connection with evaluating information related to this
permit applica, ion: - i �
Property
Signature
G� t (fiuu�I
Print or Type Name
Title
Date
This certification is valid through

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 121� C�
J
Address of Property: i _l 1110 /b I( f L
(Lot or Street #, Street or Road, City & County) J
Agent's Name #: Mailing Address:
Agent's phone V.
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letfer-
I have no objections to this proposal. I have objections to this proposal.
i ifyoulhav_eobjectionstowhatlsbetngproposed,youmustnotilytheDivtsionofCoastalManagement \ g
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
�J availableathtln://www.nccoasialmanavementne0yeb/cm/steff-Gstinaorbycalling1-888.4RCOAST.
No response rs considered the same as no objection it you have been notified by Certified Mall
`) �II WAIVER SECTION s
0 0 1 1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
JQ \ you wish to waive the setback, you must initial the appropriate blank below.)
(.� Q I do wish to waive the 15' setback requirement. r
-1 db` not wish to waive the 15' setback requirement. _
1
,i
Pnnt or Type Name
(Riparian Prope wner Information)
.Si alure
t
Print or Type Name
Mailing Address n yy G y
�djaod I!/ tit
mr rup Gotl(ta-- 1Y/N9d 1 Cdy/statelLip
�S iJ�c: r�ali�rr c%l0 -336-/ 961,
telephone Numbr/Emad Address
otDate r
Telephone Number/Email Address
_ 5-L,
Date
(Revised Aug. 2014)

ADJACENT RIPA RO
DIMSION DE COASTAL. MANAGEMENT
F'ERTY OWNER NOTIFICA'TIONIWAIVER FORM
t�ropethf Owner-
Acicrresr, of to
roilmrty
._._,.,L_
fiat lYtrebt N: SBbat Of Road City 3 rOurdyl
Agent's htatsss #
AgVi'll 88 phone rm q� M%aylr A6dms9 �_..._
�rs#y t'.eriFfy that t owli ptt7pesty ad]""sent IQ the obRVU rt• r`teeni e4 vnpprh h
they ing for thr5 permit has describecl to nee as shown on the kinarhe d diaw.ng +he leverkv "mrint
they arty pfmapasrnrg 4At31t
diTf7�_Sftlrt3Aloa tnuxt 1Ns"!.Ykt 1C+iti 1r,
I Its#ve rio objCelir+n5 M thi, pr„;rn-.;�I I h3�i.+�bjeclivns ve:: lhi� �tsrFyp�f
vw t' 7f ycru haw'a ob/'lions fo whmr s� hein,9 Proposed, yao- must notNyltno Dfulalwn alCansfal MRnBgatn®rrf
DGMl in Wridng within 16 days of receipt of this notice, Cpnfact Information for DCM ofTices is
avattablearfl£EE!L!!v ri coal Jmans nrgni,netwgtil m'statkf?stmuarbycaffingi.6184RCOAST.
. Nta r_„_� spores is cormofdrrorl tf7e earn as non ctFon Jf trou have been natif?ed by Carttried Mali.
t
WAIVER SECTION
I understand that a Ater; dock, maoring pilings, boat ramp, breakwater boathouse. or lift must
' be set bark a minimurn distance* of 15' fron-i my area of riparian access unless waived tYy me. (it
YOu wish to waive ine setback, you trust initial the appropriate blank below,)
i do wish to waive the 15' setback requirement.
f do not wish to waive the 15' setback requirement.
(Prripgtl� Owner information)
(Riparian property Owner InforMatian)
. Nk�J F-RA7etLE
Phil' of Type NarM -••
Po Sax 314
Ma;l ng Arfdrsss
1 c'1c1t? r r Pr�C 1 5YV'AfJs�o t/ z�s�
-'; IulBtylStat&Z.ys
- l;-Aphom Nijrtrb?rl E'rnod Allures
440t'
-��6'_��"'�7„I.
Tat®pbone Nutnbari Izma;;t Address
£krde
(R9:t5od At,g 2014)

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