77964A_Ellis, John & Karen_20201229

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/CAMA / DREDGE & FILL W 77964 (AD B C D
GENERAL PERMIT Previous permit #
/New 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 _ I.Y. - 1h)
VRules attached.
Applicant Name5>k,,_ * e, Project Location: County
Address_; oo Street Address/ State Road/ Lot #(s)JOC)
Phone # (?$�) 761.439el( E-Mail )93&//;,,vo.1�(.CoASubdivision7LlLg___& Y_ .
. ....
Authorized Agent claw, M—W116-el City A,*1,0(,-)c;,c)r1________ ZIP _v';Ll
Affected CW JEW efrA ES�4(nrS Phone # ( .. . ........... ) .... .......... .. . .............. River Basin
AEC(s): OEA HHF I H USA N/A Adj. Wtr, Body C4,J., 4 14 at i nan _junk,,)
PWS
ORW: yes IkLj PNA yes I no Closest Maj. Wtr. Body C-al.4ek
Type of project/ Activity Rae(c ems,.. k-koad
.. ...... . ... ............. __ ...... . ... . . . . ................
(Scale: A]
Pier (dock)Length
Fixed Platform(s)
Floating Platform(s)Finger piers) Groin length
number
uikhea)Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat r-amp
Boathouse/ Boatlift,
Beach Bulldozing
Other
N&,jk0Jli`uJ 94kkepi4
Shoreline Length 41 — -E ( I 1 . 3
SAV; not sure es n
Moratorium: 'I XZs no
Photos: no
Waiver Attached:
yes Qa)
A building permit maybe required by:
I \ Note Local Planning jurisdiction)
Notes/ Special Conditions
. .................... ............. ..
Agent ur AlJiplicant Printed Name
Signature "Please read compliance statement on back of permit"
** q 0("— G o I�Icb �
Application Fee(s) 1`pCck#
See note on back regarding River Basin rules.
Rz�ert carbcff�-__
, -i w, Officer's Print ��V
Pe �6�
Signature
1;2- - a
'suing Date
Y - CP_ I - - L L ��
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: JoHAJ EIS
Mailing Address: 1 oto 84rZ1?Ac-vD4 S i
M 0\i O c-<C , rJ L '1 ! S
Phone Number: (-7S -►.� Z'S 9- � 3 a q
Email Address: 1 `tJ r✓ LL.IS 6C) to C-rMNtu. t.eM
I certify that I have authorized;rAPPS ,
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: IsU L je-1-tc-/*D
at my property located at )W ,
in County.
furthermore certify that l 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:
"4
Signature
Print or Type Name
Title
1 Z / 1 / 20 ,2,0
Date
This certification is valid through i Z" I I / 2-4 2o6-

a to items 1, 2, and S.
s Print your name and address on the reverse
so teat we can return the card to you.
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1. Arbc* Addressed to.
j it
C--a(ck Az
..: �.s Aigent
X _ Addressee
B. Received by (Printed Name) G= gate of Defivery
D. is delivery address different from item I?
If YES, enter delivery address below: No
3. Service Type 0 Priotity Mag ExpressO
El Adult Signature ❑ Registered MailTm
❑ Adult Signature Restricted Delivery
❑ Certified MailO D�
❑ Certified Restricted Delivery a Rat
9590 9492 5566 9249 7996 87 ❑ co n Mail
eliery Memhandise
la Signature D
dirFir itlr orwehcsr lirrt#asr firm e•rreir.n Lehr F9 (� C'nNar^t on Delivery Restricted Delivery
l MaII 0 Signature
7020 0090 0001 8379 4051 1 Mail Restricted Delivery Restricted DoWev
Donvstic Refurn Mgt
PS Form 3811, July 2015 P 4r 7,530-02-00w90 3

: Cornplete items 1, 2, and 3.
N Print your name and address on the reverse
so that we can return the card to you.
It attach this card to the back of the mailpiece,
or on the front if space permits.
1. tC�e ltfdr 8U tp:
-�7 (,try
r
ju
•, „
83?
4044
9` 0001
A. Signature
0
Add
resow
B,.Received by (Printed Name} FDate of Down
f
D. Is delivery address different from item I?
If YES, enter delivery address below: 177 No
3. Service Type
l Adult Signature
€I Adult Signature Restricted (delivery
171 Certified WHO
H Certified Mall Restricted Delivery
"I Collect on Delivery
Collect on Delivery Restricted pellv*ry
'noured ball
I Inauro(1 Mall Restricted Delivery
i-e`ttY tKnAl
W

f
Description: Construct a bulkhead the length of the property 2' from the current bulkhead if allowed by
the state. The new bulkhead will close the current boat ramp and backfilled.

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