76176D - Horne

CAMA/ XDREDGE & FILL No. 76176
D
GENERAL PERMIT Previous permit# A B c
)`; XNew 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 5A NCAC 07 ii• /1 t)6 •
E Rules attached.
Applicant NameJOUC[ /lo�nt Project Location: County A1?,tom i4t7L/ Q4
Address aa t.,,i,,1rQJ115. Read StreettAddresss/State Road/ Lot#(s)
City Wr IyN1iv)(r - State/Nc, ZIP o� Del a j 1 Wt Raw s Qd
Phone # ( ) bACI SSA, E-Mail dtioifie" 771,6 rife*, Subdivision -
Authorized Agent Ji Nkti l7 Np i' City ZIP
Affected ElCW DEW /❑PTA NES k PTS Phone # ( ) _ River Basin
Ill OEA HHF IH USA ❑N/A I Body (nat /man /unkn)
AEC s : Adj.Wtr. w�
❑ WS:
ORW: es / no PNA )e�/ no Closest Maj.Wtr. Body Ma 5�6�'Q &4' c(
P
Type of Project/Activity Ple pe sat "IC rYiS /( I/K/4 ,,I ;A k jee i -filio 1z7A-75irh) /17ll
JK lkI vGci/ (Scale: /; 3 )
Pier(dock)length — .
a
Fixed Platform(s) __ r ,1 fi'fn j r7::y r at
Floating Platform(s) .? Z
Finger44-
pier(s)
Groin length --- jiO6 i--. MEd • Ma 'ram s,; i
number �• J1� ih ,io
Bulkhead/Riprap length j 3.5' K!'v . /Yet. firm0 i
� � tj 1
avg distance offshore (J '✓r �l iv
max distance offshore U / i S. • ___ i
Basin,channel 4. =4-Im — I
Yv,4'
cubic yards +' ' lug 5: : /L
i " PaPfe,/141.1 4 ti ..
• Ito runner. I
Boat ramp -...•.•
Boathouse/Boatlift I .l -.7-1E5j LA,a6e, --
' �f A d l -- I -
Beach Bulldozing r /..7�II . j - ---
Other t"nTVrrt to �' SI� �. `_ 1
•
% .
ler .• .
.50t.s.
j__ , .
., i ,:: /I,a '
-• .
Shoreline Length V Dr,y
SAV: not sure yes ® 1 i
Moratorium: n/a yes
Photos: yes ® IL'
Waiver Attached: yes ® -
A building permit may be required by: t'4 b/ On/a . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions ,
%n s rm� 4 i is exit/7 `9� la ic�,s 4fl m be*, �e c'c n J,)7
sa4wiQ 44 n ri 4 S na_i /VQ co-, r 404 werra4
/ 1 1(et i• / i )^s r Fa t-ria 7r((
Agent or Applicant Printed Name ) PermitOfficer�s Printed Name
,` .
Signature `*"Please read compliance statement on back ofpermit** ignature
8 P 8
Application Fee(s) Check# Issuing Date Expiration 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 (252-946-648I) or the
Wilmington Regional Office(9 I 0-796-72 15)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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: --aous Ia S ile).- u
Mailing Address: r2g2. W 11`L Isms tzd
lLY 1 Iv-LcIvr), N C- 2�1t o9
Phone Number: 10 ( 2 r5 gli3
• Email Address: 4 )c)r n6 —171 yct14 oo. CA
I certify that I have authorized y /\3 J2k,
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: y9 13 �2 b //c h'ad
at my property located at r,2 2 & ; </; ay s 2 j
in Pry biG,, .0L)lCounty.
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:
s-D atitAL 1"L"-12-
Signature
Do O L-,1-SAS OIL N s
Print or Type Name
0W UM-- -
Title
/ It -2_0,-1
Date
This certification is valid through / /

V.r•w
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to • iôu s i S 's
nn ,(Name of Property Owner)
property located at • : OA.vA.J S 114.6/.
/ (Address, Lot, Block,Road, etc.)
on. Mllc,mj t o ro , in 10,/i /e..S(Y3.., , N.C.
(Waterbody) (City/Town and/or County) •
The applicant has described to me, as shown below,the development proposed at the above location.
I have no objection to this proposal. •
• I
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development mast fill in description below or attach a site drawing)
1 l A11
aPot Lit Nt-iP z 5 d (2e )1JIM) W•
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ew r rut-)(�rr3CkDp
•
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.
•
(Property Owner Information) (Adjacent Property Owner Information)
DavtMd4 1 /VAAlla
Signature Signature
DO was 1- ) R'J Vincent R Smith
Print'or Tve Name Print or Type Name
LLI f Y 284 Williams Rd
Mailing Address Mailing Address
WM%11.+(,-1✓U1U1 N C 21401 Wilmington, NC,
Ciry/St e e p
_��1)r5 4 3 City/Stag 0�-791-1760
Telephone Number Telephone Number
01/13/21
Date Date
clIwrn� ` i �, `jahoo`e01^ VfZSgy►w@9mA'l.Corp.
(Revised 6/18/2012)

mA�
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �ay Ic S �10,N t 's
12a me of Property Owner)
property located of. . g�- i ;/f d ti s
(A/ ddress, Lot, Block, Road, etc.)
on. ►` asoi.J 'oro $Qu, of , in (A ); /,q/A-3(11j
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
•
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)
• i
. t
i
a 12 riA s A1L
>;.E AT`6A-C11-0) w :n
•
•
•
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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.
•
(Property Owner Information) (Adjacent Property Owner Information) •
cDONAOtto
Si ,Z.?4,/,'174 •
gnature gnature
Print or Type Name Print or Type Name
Mailing Address i Melling_Address •
rtLmI�hTDI , jLgit rn9
City StateTZip TV/State/Zip
V1do— & o_531` 9W) ,Y 8. .7
9))
Telephone Number Telephone Number
Date DatC
dhornq.'irll ' yet%o6• +uw�
(Revised 6/18/2012) •

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Chock
Date Received Date Deposited Chock From(Nema) Nem.or Permit Holder Vendor 11/ amount Permit Number/Comments Receipt or Rehnd/Real ocated
Columnl l Conn! Column3 COWmn4 Column. Columrn@ Camera Column! Columne
_ 2/9/2021 Allied Marine Contractors LLC Laura Olsen FCB 9832 $ 400.00 GP*77742D JD rct.12387
2/9/2021 Allied Marine Contractors LLC Nancy and Bob Carr FCB 9831 $ 400.00 GP#77743D JD rd.12388
2/9/2021 Allied Manne Contractors LLC Robert and Sarah Clark FCB 9758 $ 200.00 GP 977766D JD rd.13622
2/9/2021 Sea Dog Marine Construction,LLC Donald McVickers First Bank 1230 $ 200.00 GP#74368D I7rnac rd.13592
2/9/2021 Sea Dog Marine Construction,LLC Christine Cichan First Bank 1233 $ 200.00 GP 577804D Tmac rot.13595
2/9/2021' Sea Dog Marine Construction,LLC Edwin and Wanda Turlington First Bank l 104 $ 400.00 GP 9775400 •Tmac rct.13594
2/9/2021 _ Coastal Marine Piers Bulkheads LLC_ Mark Sirgo _ Wells Fargo 23717.$ 200.00;GP 976182D PA rct.11583 _
2/9/2021 Coastal Marine Piers Bulkheads LLC Douglas Home Wells Fargo 23718'$ 400.00 IGP 076176D- PA rct.11584