77755D - Russell

0 CAMA / DREDGE & FILL N° 77755 A B C
GENERAL PERMIT Previous permit#
)C ' I New Modification Complete Reissue Partial Reissue Date previous permit issued /
As authorized by the State of North Carolina, Department of Environmental Quality O l 1`, (C�--� )
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
0 Rules attached.
Applicant Name (72.f , C ! �j.'� Project Location: County I �S t C i12 -
Address U , - ("T St _ Street Address/State Road/Lot#(s)
City .-. &)U-• _ State '�(..._ ZIP 'ZS. 16 __
Phone # (-ni IL-) E-Mail -. ..cc' r fa ,Ak Si2 Subdivision
L 9�G, %
Authorized Agent An•-1 -.`,\ ��(1 4 ,^ `c°'-City ZIP
CW i .EW ,PTA DES ❑PTS Phone # ( ) River Basin
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body (ocio S e Cne-e k- Clrj4/man unkn)
❑ I
PWS: l'tc,kkotk e_'`...)t1—
Closest Maj.Wtr. Body
ORW: yes /,no PNA yes /CD
Type of Project/Activity ( ,,. -t.?7- Oe s ., N i OCR :__,.`,_ _, r i
J (Scale: N .S )
Pier(dock)length lP )(( d
Fixed Platform(s) �. 1 ��,� r I"
Floating Platform(s) l / _00 S� C�yL �'1 -~� ..-
Finger pier(s) _ --.. i I 1 ' '
Groin length i]F`SVtG S ,—+"+.+
number
Bulkhead/Riprap length - ! ' 4
avg distance offshore w
max distance offshore ^ .. 4 .V
Basin,channel —,. r. V rl Vv. ! i {
i
cubic yards I .� ' I �
I i !� ►�Boat ramp n. I ' f'
Boathouse/Boatlift 1- —. A._ ..
t —, i
Beach Bulldozing 1
�
- .1. " f
Other 1.„ i
l � i I i I r�lL
. { f I j i
Shoreline Length
SAV: not sure yes CO titr-
L AG& J SS�`` J M/f' �1
Moratorium: n/a yes C.3 < V f
Photos: yes o I
Waiver Attached: yesdi. I ✓ I , E ' --
A building permit may be required by: \ �.� .S......., t C`C als...`-t' E See note on back regarding River Basin rules.
( Note Local Planning Jurisdictiona
Notes/Special Conditions ` NC C2 S S t 4- "" ...+l\1 (� V� P n�(�c f'` t \� ( h4'^^eeKCf1�rLLi L L-.NQ o T c...GL- i►"UA . N a 51. r3 QL..t f\uei t2 G`
,..., ),-\,-, s ct.r.", t
SL,c. A chtC- 1, „f.,_.....,4.-\ �0*-oc,1(..�
Agent or Applicant Printed Name Permit Office • ted ame
Signature Please read compliance statement on back of permit**,,„T.
Signature
,A 2_c_)00-3--
3--/- S-7-
1/2-- /'-? ‘ 5/2 q/2 /
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 1 5)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 252-946-648 I
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

•
El
III, E/RAL DOE&FILL N9 77755 A B cCV -
PERMIT
Previous permit#
�J•A) .ew OModification ❑Complete Reissue DPartlal Reissue Date previous permit issued
As au horized by the State of North Carolina,Department of Environmental Quality �J
and the Coastal Resources Commission In an area of environmental concern pursuant to I5A NCAC 0 f 1�
r.-� ORules attached.
Applicant Name s.1'e-'(o r LJ q.1 Project Location: County i t.�S L. e'SL
Address V E- rel.' I _ Street Address/State Road/Lot#(s)
City- 1 State[QC,ZIP z50_kla
Phone#(f o I O E-Mail - 1 • c: t\t'''@ . Subdivision
Authorized Agent nr.1 1S (1/e 1 9 "rCity ZiP '
Affected MEW , PTA ❑ES OPTS Phone# (_) River Basin
AEC(S): DOFA ❑HHF ❑IH ❑UBA ON/A ff��� tt__ /jam/
O MS: Adj.Wv.BQdy V�O'S CJte e:K man /unkn)
ORW: yes/ t�l _ PNA'; yes I tiED • Closest Maj.Wtr.Body• \l°1-{e•1- "s'c,✓-
Type of Project/Activity._✓�s �� ..5 • X (�� G�CC.e_S S _�1 eta
Pier(dock)length (0 f i((Ov ' (Stale: S )
Fixed Platforms) -- -L i I 4 ,r i 1 I 'v 1 i I 1 "c i l i•'i I I _ I 1 1 1.. 1 . I
floating Platform(s) �i- ^bL.C) - _ I-. I _ 1 i.- ``=i
pier(s)Finger I i 1
1111
Groin ..GS tT --
ntnnber
Bulkhead)Riprap length • �_ --`- ~- } _ _ '`�•�-
avgdetartceoffsfigre - IIIII=
; , y. .a _• �■C _ ■
max distance offshore • l i l i
1 _ 11 , �. , i 1 1 H�1
i . "s_t_
f _____ U_Y! ni�MEiv�Oi•
IN_____id __:! cubic yards i
I •
ramp I
Boathouse/Boatlift I i 1 - -! • ■ 'A. i� !♦ `I '
Beach Bulldozing ____1 , I-- -', ---r- - z i i •■
Vtvh- ! ■ — -1-1
1 11 I i
Other i j _ a ii i l
1 III ( i i l i
y.� I i Ii i 1 I I Ti 1
Shoreline Length 7 0'I ( 1 1 i 1 I ` ' -j 1 1 I -L-L-_
SAV: not sure yes no -S`'ttril.J,: - .- - - 1 i I_ , S'�1l l`- _H -(t- _=.,. 1. ! i 1-
Moratorium: Na Yes c ( .O - --- - -..__-- . - _- '--rt _ _1 7_ _
Photos: Yes 6ti-4 - . __ --_- 1. --` I- ,- -:.: -1 , -- --�-
Waiver Attached: yes a, - 1 1 # ��
A building permit may be required by \ /.,.ttiS..,,, t e,1C, .,,,• ❑See note on back regarding River Basin rules,
(Note Local Planning jurisdiction .
il Notes/Spedal Conditions ' -SS ►L/ `.:,( 1 'a ,ntr.rcy� -Itk t p
Cnn4
.� c 1 �.• .e Lae. lac+ .t n 5 I.e.. Gl�:il,..., te_
Agent.o:14451 icantV;IX-41.
P.. name Pem.,1 tea ame
�rc+ture °Please read comp0an£e statement onba o ermite'fp &gnawre '
i 2 . Z s 29 ziP
ApplicationFee(s) Check* Issuing to , .
Expi tion art=
t
Scanned with CamScanner

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:. (-52, .TA P.J4k5Sei l
Mailing Address: aO 1 ta.5-
Phone Number: 7 7 - 1 l 0 q
Email Address: -rr'ck55 e ( ( 5' G=M021/41 .Cv�
I certify that I have authorized bn cs c RAJ Z
Agen /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 3 X . I 0 Q Pi sc-
at my property located at I gO 1 ��e;� <{ ,
in _ `.mil A n +/�r 1C 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:
Prope Owner Information:
EAA—e-el
Signature
GERA Lcs, E pus s ELL—
Print or Type Name
Title
I
Date
This certification is valid through I I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Prop.erty: < C) S-LS-kaiLttr-Vc n C_
(Lot al-Street#, Strbet or Road, City&County)
Agent's Name bek...S-c Mailing Addreas: al IQ c( Boo tv s fS
Agenfs phone#: 9_10 aoo svekl
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 attacheddraWirieg jhe development
they are proposing.A description or drawind.with dinienSiOns, must be provided with thieletter,
VI have no Objections to this proposal. I haveohjoctions to this ptoposal,
if you have objections to what is being proposed,you must notify the Division of Coastal Management(DCM)in
writing Wit10101cloys of receipt of thiknotice. Correspondence should bie mailed to 127 Cardinal Drive Ext.,
Wilmington,NC, 284054845. DCM representatives can also be contacted at(91O) 796-7215.No response is-
c-onSideted,the same as no objection if you have 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 unleas waived by me. (If you
wish to waive the setback, you must initial the appropriate blank-below.)
I do wish to waive the 16'setback requirement.
I do not wish to waive the 15'setback requirement.
i(17operty Owner I fo ation) ( jacent Prope Owner Information)
( 1•Gcl4OV te(41) ,
Signature Signature
( -ex' AcQ.u,se_11( Decvn S..51.2mAy\s24-
Print or Type Name Print or Type Name
tQi E--ewc:A , rot k--•
Mailing Address •-1 Mailing Address
.96 n C 17o 'kJ!b& n c_ aki b
city/Siete/Zip City/State/Zip
7-7-4 (0 0(1 ?Io175-g 1
Telephone Nurnber Telephone Nuthber
atea-a/1'A%. CA 0-60\ I 1,11Y711
Date
Revised 6/18/2012

.ENDFP• COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ COtprolik items 1,2,and 3. A. Signature
IIPrint your name and address on the reverse X / ent
so that we can return the card to you. '/./4(5:-:......._4SiltZeri
'dresaet
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
I. Article Addressed to: D. Is delivery address d" from item 1? s�[r'�
If YES,enter delivery below: a;•.
1IIlQm 7I1
ry...,.�^
c96,60 a c?3 -T b vi
13 4, k2( , VA a4 6
1111111111111111111111111111111111111111111111 ❑dulice Type
ltSign Signature Restricted D 0 Priority Mail elivery 0 0 Registered Mail Restrict!
9590 9402 4454 8248 7497 22 • rtified Mail®
Ceertified Mail Restricted Delivery 0 DRReetlry
um Receipt for
❑Collect on Delivery Merchandise
?. Article Number(Transfer from service label) 0 Collect on Delivery Restricted Delivery 0 Signature Confirmatlonn
0 Signature Confirmation
7 018 0680 0000 7025 3939 I Restricted Delivery Restricted Delivery
>.0 Fnrm ARi 1 Auk/oni c Dent 7c5tn_nosrn_onka nnmactir.Return Ranaint

USPS TRACKING#
First-Class Mail
r l l'II I n" 270 Postage&Fees Paid
USPS
11111111111111 i. .� 4 L1111 Permit No. G-10
9590 9402 4454 8248 7497 22
United States • Sender Please print your narr}�,adgy Bess,and ZIP+42'in this box'
Postal Service ne m i 4 P' -(1
aio &S5- vc,(55ei i
PkII . JJ L. aD
tI 1l11l1tlil1I1I 1ll11.1161.1.„,por,lil,llilmJId„p,III

• • , CERTIFIED MAIL • RETURN RECEIPT REQUESTED ,
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM R
Name of Property Owner: (sc A- `-
Address of Property: M k 2# 7-, St-Nao 11 C
(Lot or Street k'Street or Road, City&County)
Agent's Name#T&�c\( I Pa i��z Mailing Address: &'.G rvik k_
Agent's phone#: 9.l 0 abe I%\6 S u t o\ (\C &L 1- a
. 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 letter:
I have no objections to this proposal. I have objections to this proposal,
if you have>objections to what is being proposed,you must'notify the Division a Coastal Management(DCM).in
writing within 10 days of receipt of this,notice: Correspondence should he mailed to 127'Cardinal Drive'Ext,
Wilmington,NC, 28405-3845 DCM representatives can also be contacted at(910)796-7215.No response is-
considered.the same as no objection if you have 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 blanks below.)
I do wish to waive the 15'setback-requirement.
I do not Wish to waive the 15'setback requirement.
•
( perty Owner Inform,. nj (Adjacent Property Owner Information)
I�d4
Signature Signature
G--e.calili . c..k.k --,,e Q.( GO, \ 1 eg.fv\i c- "k-Cx- I''‘(
Print or Type Name Print or Type-Name
r 6O I �-ck �\-. aU(CA m� c " 1�1.
Mailing Address Mailing Address.
Skulk n( aR470 $lilt v_S‘o / ' i(-e(6
City/State/Zip City/State/Zip
nri a'r1 6 - C(o oel
Telephone Number Telephone Number
,�4 d 9 a--eia i -
Dat I Date
Revised 6/18/2012

I ra 1J w-VI_ c-n
M .4
• -f"3 10% 1 3' )C IC7v' l e(
•
-
`4! ) ,1ww is vada.

. .
REcENED
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
• 30 2
DIVISION OF COASTAL MANAGEMENT 6 zoz1
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
NG-TON, NC
fl DCM WILMI
Name of Property Owner: Ge Ici2ZAIL
Address of Property: t't ' k t-c:fa SL St-Nab ik n.c
(Lot or Street tStreet or Road, City&County)
A(Z6N
Agent's Name#706.1\A bik4 ( alfh^(1 Mailing Address: /Ag21,1741..a,
, Lt
Agent's phone#: 9 to D...bo i%1(43 StAfc)l\ tc\c_ .&•-L4--ri;.a
_______Lhereby_certify_that-I-own property-adjacent-to the aboye-referenced-properThe-intliVidtial- - - ----- --
.
applying for this permit has described to me as shown on the attached drawing the development
they are proposing.A description or drawino.with dimenSions, must be provided with thit letter:
TVI I have no objections to this proposal. I have objections to this.proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management(DCM)in • -
writing within fo days of receipt of this Wee. Correepondonce should be mailed to 127 Cardinal Drive Ext,
Wilmington,NC,28405-3845. DCM representatives can also be contacted at(91O)796-72 f 5.No response is
considered the seine as no objection if you have 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.
V I do not wish to waive the 15'setback requirement.
(illperty Owner Inform - n) (Adjacent roperty,own r Information) _ _
. / • d s. - (ato-e-e
Signature VSignature
G-eca.k _ kL SS.a
LO,q1evatv
Print or Type Name Print or Type Name
ISOI ,, •C•C.4- S\- . D-kao . rA4-:7-6...bo,c t
Mailing Address Mailing Address
sRatifc nc a5470 Itvs\ ,,. VA ‘a(f-6(06
City/Stateaip City/State/Zip
nrt 1( —an 6 - (co 0 el SAO r5g-2- (a gS-- 0
Telephone Number Telephone Number
1 \11AA, d 9 ()-eiai - JA0 2 ,
0 -2_02. 1
Dat 1 Date•
Revised 6/18/2012

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9
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Chock
Data Received Dab Dapoa#ed Chuck From(Name) Name of Permit Holder Vendor 11/ amount Permit Numher/Commenta Receipt or R.hund/Real/ocated
Column', Cofume2 Column] _ Column./ Co/umna Cdumna Column? Columns CaemnP
2!4/2021 2/9/2021 Harbor Marine Construction,Inc. Bob Hale Bank of America 1156 $ 200.00 GP#77773D JD rct.13621 -
2/4/2021 2/9/2021 Conrad Fey same Bank of New York Mellon _ 1084 $ 200.00 GP#77776D NE(Cl.13668
2/4/2021 2/9/2021 Lighthouse Marine Construction Inc. Vincent Garofano Coastal Bank and Trust 3609 $ 600.00 GP#77741D JD rct.12385
2/4/2021 2/9/2021 Lighthouse Marine Construction Inc. Douglas West Coastal Bank and Trust 3608 $ 400.00 GP#777400 JD rct.12384 __
2/4/2021 2/9/2021 B and B Marine Construction Money Order Chuck and Mary Jones Wells Fargo 19-088347329 $ 400.00 GP#77801D _ Tmac rct.13591 _
2/412021 2/912021.Permit Pals Charles West iCresCom Bank 3736 $ 200.00 GP#777540 BB rct.13519 __
2/4/2021 2/9/2021 Jason M.Lach Lach Revocable Trust First Palmetto Bank 1839 $ 200.00 GP#77756D BB rot.13521 __
2/4/2021 2/9/2021 Permit Pals Gerard Russell CresCom Bank 3737 $ 200.00 GP#77755O BB rct.13520
2/4/2021 2/9/2021 Joel E Brown same Fidelity Bank 4440.$ 200.00 GP#77759D B8 rct.13518 -_
2/4/2021 i 2/9/2021 Grice Construction of Brunswick County Inc John Dwelle BB&T ___ _ _ 14385 $ 200.00 GP#777290 88 rct.13516 __
2/4/2021 2/9/2021 Grice Construction of Brunswick County Inc Marshall Newton 688T - - - - 14384 $ 200 00 GP#77728D Be rct.13515