Jone, Susan 76714C

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❑,CAMA / ❑ DREDGE & FILL { ., N9 76714 A B C D
GENERAL PERMIT Previous permit#
9New ❑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 attached.
Applicant Name Project Location: County Z c i / r'•'''' _
Address Street Address/ State Ro Lot #(s)
.Cif t t , i State / °'� ZIP'
Phone # ('') I )` � E-Mail Subdivision
Authorized Agent iif a'/h/h ��' ��r" ` City ZIP
ocw pEW El PTA C'm ❑PTS Phone# Off_ River
Basin
Affected
❑MHF ❑IH ❑UBA ❑N/A
AEC(s): 00EA Adj. Wtr. Body mat /man /unkn)
❑ PWS: i ..
ORW: yes / no ) PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier' _ _,.. .__—,.
Fixe,
Float
Fing,
Groi
Bulk
Basil
Boat
Boat
Beat
Oth,
Shor
SAV
Mor
Phoi
Wai,
A building permit may be required by: l �'
( Note Local Planning jurisdiction)
Notes/ Special Conditions
r " )
Agent or Applicant Printed Name
CJ.
J7
Signature "* Please read compliance statement on back of permit"
Fee(s) Check #
(Seal/ V 4'" )
❑ See note on back regarding River Basin rules.
PermitOfficer's: ri/tted Name
Signatur, pp -
Issuing ate ! Ezpi ar 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, 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 howtocomplywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
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 7/06117

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: N jC)f-j
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
I
to act on my behalf, for the purpose of applying for and obtaining all
_CAMAAppermits
necessary for the following proposed development: �rh w e �i ri le
at my property located at 3 U k
inCounty.
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:
Print or Type Name
Title
b I'9� ZI9L�v
Date
This certification is valid through /)-_/ 3 ( i 1qUA v
'RECEIVED
MAY 61 2020
I
DCPM-NAND CITY

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
- ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Y Scz, Ad JO.(J C
Address of Property: 5r 6 6A/ ( Ur 0wwti1-A-)cx JVN
(Lot or Street #, Street or Road, City 8 County)
Agent's Name #:-4w� h5 L 6!1: ' ,g c .0 Mailing Address: %5�-3 / l� oz,
Agent's'phone #: 5` C G.. % 7 ,� 5 �1 I ` JQ /y C �IS3 J
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 drawin the development
they are proposing. AsQ fpf[an il'd° vying iff
s ebo•detllt`te.
!' I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you mustnoflfythe Division of Coastal Management
(DCM) In writing within 10 days of receipt of this notice.. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC,28557. DCMrepresentativescanalsobecontactedat(252)808-
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Proper Owner Inform ion)
Signa re
Print or Type Name
Mailing Address
CitylState/Zlp
Telephone
//Number
Date // //
Property
Print
EIVED
� O MAY 01 2020
e�
Date DCM-NIHD CITY
Revised.611612012

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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: C[, AU JJ O,L) C
Address of Property:
(Lot or Street #, Street or Rdad, City & County)
Agent's Name #:�w Mailing Address: 75.3 1 �L n� cr?� c r C 4
Agent's phone #:
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 drawin the development
they are proposing. RA�s11�io`fiad aig�t�imeraa�SbYow e�t�tei.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notBythe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. _Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response is considered the same as no objection if youhave been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
(Prop Owner Information)
7 Allkvv
Signa�tu7 e
Print or Type Name
30�'tr,"J�r
Mailing Address
City/State/Zip
),-79,9 - 9(0 'i, I
Telephone Number
�/ Q= -7 AA
Dates /
(Adjacent Property Owner Information)
Signature
02�*r1e5
Print or Type Name
3 0 \ 6 A� V--�
Mailing Address
SV,A%"^A/C IW6
City/State2
P,
I'
25-L 2`i\ (01RECEIVED
Telephone Number
2� 20 ZD MAY 01 2020
Date DCM-MHD CITY
Revised 611812012

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