74282D - Sheppard

0 CAMA / DREDGE & FILL No. 74282
GENERAL PERMIT Previous permit # A BCD
>G New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality --7 ,T 1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC [ V V
E Rules attached.
Applicant Name ' 1\ LI C Project Location: County _ ( iyV)jk. `C_1L..
Address -VD c - Street Address/State Road/ Lot# s)
City 1 � T State MO,ZIP .• id- .��D � _ 0L �J 1 �• �(.�m_-
Phone # ( U I.�b`I ` (X�_MaiI Subdivisi n // � _
Authorized Agent 1\I A \AA(A City �` `e ) (yC�r- ZIP c G-i LO
Affected ❑CW -411.EW L TA ❑ES ❑PTS Phone # ( ) River Basin
❑OEA ❑HHF ❑IH ❑UBA ❑N/A l
AEC(s): Adj. Wtr. Body el Q�s, _., l'�1_./ nat nkn
PWS: lV +/
ORW: yes /R PNA es / no Closest Maj.Wtr. Body
Type of Project/Activity V y \' k\vlC/\ ( L11)UL ( \1(t\ lr \V 1 Uv ./ I ,
(Scale: 1`� )
Pier(dock)length
- I �,.��j 1
Fixed Platforms) + tiff I-.. 1 4
Floating Platform(s)
+. Gam--
......„,i--;,,4 ' 1,0,
Finger pier(s)
Groin length 0 1 , () 1 t 1
number
Bulkhead/Riprap length 1
r
avg distance offshore } •
i
max distance offshore
Basin,channel /
Ll 'At
cubic yards P', e `- j� r,•!1,1'1.6�
. r -PA..-
Boat ramp i ♦ _
4.
Boathouse/Boatlift 1I
?.tee.* ' + ir '110 - -—
' 'O<e {.N�
Beach Bulldozi
Other
L ( � i 4 n
Shoreline Length •J�IVJJ SAV: not sure yes )(:i%\ ._ • --1- ek- , ;
- -
Moratorium: n/a yes 2.t j /
VAN Y .)
Photos: y no1(2 Q . ,
Waiver Attached: X, yes no 1' r
‘Al '/
A building permit may be required by: W. lCLLCt n See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) I I
Notes/Special Conditions OJT`1 I 1. U` v I et,,k6`/ lL;
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,ram ,- PermitOfficer's Printed Name ,
A ' ---atc" i A / .. ---,-
ature **Please ea,c•mplianc- .tement on back of permit** Signat e i'
11 / L_I___ •
Application Fee(s) Check# Issui Date xpiration 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(9 I 0-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: &l!'. 5pi, J
e
Mailing Address: I7 Tq-- ) ,Sf
/WW1/ 16 •
Phone Number: 7oL/- ( Oq- °1pL5
Email Address:I certify that I have authorized l `!Itd / �� Jraiiç
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessaryfor the following '! 1 proposed development: � /� hork, t
at my property located at Fast- XAP_AAK—),
in /,, iv►e,)L 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 evaluating information related to this
permit application.
•
Property Owner Information:
Si nature
iri i 5 wd
Print,or Toe Name
Title
/a I quo I ob
Date
I[YI
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
f'C/
I hereby certify that I own property adjacent to 8n e , 's
(Nan a`f Prope Owner)
property located at
�,-./ (Address, Lot, Bloc , Road,e .) r /
on DWIS 6'``I , in , N.C.
(Waterbody) (City/Town and/or County)
The appfcant 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 fill in description below or attach a site drawing)
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F.(cetki (6Y;?)
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pen.
WAIVER SECTION
I understand that a pier,:dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set ba minimum distance of 15'from my area of riparian access unless waived by
me. (If you w to waive the setback,you must initial the appropriate blank below.)
I do wish to waive the 15'setback requirement.
1
„
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Adjacent Prope Owner Information)
igna Sly �fPl Sj Cd �lcow('
print or Type
YpeforlC]37L Print or Typei Name
Mailing A re s Mailin d ess
7,161yro �,. � �� ayes
City/State/Zip . • City/State/Zip
'ly-ray- • ��- �/S 1- 165 1
Telephone Number/e ail address Telephone Num er/e ail address
Date . / Dale" r
(Revised Aug.2014)
• *Valid for one calendar year after signature* 1 • I• •

ADJACENT RIPARIAN PROPERTY OIIU t!EC STATEMENT
I hereby certify that I own property adjacent to _.s� �i'C/ 's
(Nam . of Proper Owner)
property located at R�pz �9 �
(Address, Lot, Ello c, Road,a :)
• on. d5 64 , in Uk /<rr�/ , N.C.
(Waterbcdy) (Cltyii'own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iocati9R' '`
b I have no objection to this proposal.
•
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOS%D DEVELOPMENT
(Individual proposing development must fill in description nelow or attach a site drawing)
(isYI?)
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l',t sif
j
pier
`
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 tha appropriate blank below.)
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requi rernen-.
`' (Property Owner Information) (Adjacent Prop rty Owner Information)
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Print or Type Nam MallNalli
Mailing A re�s
eM o d "�� irAngi2 a�
City/State/Zip /Siziti Telephone Number/ ail address Telep ne it`:J ber/email address
1-2/ �� . ' �" 1 a 1 •
Date
Date"
*Valid for one calendar year after signature*' (Revised Aug. 2014)
bfr;

Clack
Data Received Date Deposited CMck From Lainel ___. Name of Permit Holder Vendor 11/ amount Permit Number/Comments Receipt or Refund/Reaibceted
Colwell Cdunn2 Column.? Column,/ Column6 • Columns Cdunn7 Column,' Column9
1126/2021 1126/2021 Elizabeth Edmunson Robbie Edmunson State Employees CU 5021 $ 400.00'GP#77736D JD rot.13805
125/2021 1/26/2021 Holden Docks and Bulkheads Cathy Louden CresCom Bank 3650 $ 400.00 GP#77726D BB rot 13505 _
1/25/2021 1126l2021 Allied Marine Contractors LLC Janet Friday FCB 9757y$ 200.00 GP#77737DJD rd.13808 _
1252021 126/2021 Brandon Grimes Money Order Barry and Seena Gudelsky Wells Fargo Bank 19-088347337 $ 400.00 GP#77652D BB rot.13581
1252021 1/26/2021 Brandon Grimes Money Order Kelly Coy Wells Fargo Bank _19-088347328 $ 400.00 GP#71860D BB rd.13579
1252021 1/26/2021 CLTMC.Inc. Paul Watson 'FCB _ 1158 S 800.00 GP#775390 Ben rd.12456
1/25/2021 1/26/2021 Allied Marine Contractors LLC Barry Sheppard FCB _ 9737 $ 200.00 GP#14282D Tmac rot.13582 _
_1/25/2021 1/26/2021 Allied Marine Contractors LLC Paul Dobranski _ FCB . 97381$ 600.00 GP#777040 ;Tmac rct 13583
1/25/2021 1/26/2021 Jerry Ennett David Moore Coastal Bank and Trust -i_ 3580 $ 200.00 GP#77527D _. JD rct.13608
__ 1/25/20211126/2021 Rainwater Coastal Canabuetiort Herber and Michelle Smer First Bank . 358 $ 200.00 GP#71864D Tmac rot 13585
1/25/2021 126/2021Kevin Morse same BB&T 2696 $ 200.00.GP#77841D PA rct.11579
1/25/2021 1/26/2021 Overbeck Marine Const.JDaniel Shirley Carrie Fates Suntrust - 5388 $ 400.00 GP 075172D PA rcl.11580
1/25/2021 1/26/2021,Phyllis Smith money order same BOKF,NA ,20944262475 5 200.00 GP.77590D •KE rct.13665
1/25/2021 1/26/2021 Roger Davis Roger and Perry Davis BB&T 5446 $ 400.00 GP#76493D PA rcl.11581