79037_Flora Moorman_20210129

•ICAMA/ DREDGE It FILL N9 79037 A & C D
i GENERAL PERMIT Prviottspermit# nia
New Modification Complete Reissue Partial Reissue Date previous permit Issued
As authorized by the State of North Carolina,Department of Environmental Quality I`
and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC 7/7 r //oO
�; y& '
rules attached
Applicant Name-("(t, � , r .".s.s, Project Location:County 7aa--
Na
Address rf() (234.)./ .2-3 I Sweet Address/State Road/Lot 0(s) / /vs✓K.
City exh'X State AR-ZIP 8 Sic) //, -
Phone#(5)) f2VE•MaII7-lvr€eee-•p•3:s.uetds Subdivision U --------
V
Authorized Agent fi ��� City � '""C_- ZIP Z 8 S/a
Affected CY1r Ew /t_•„A kEs )(OnPhone# V7};y/75 99ZYRiver�Basin NV-S
AEC(s): oEA 'NNE IN USA WA Ada.Wtr.Body N ua•c-S-c GCraf"" sle6/).1/tanks[)
PWE a.i'' �
ORW: yes no.) PNA yes/ Closest Maj.Wtt Body Q '"«t' A l�-.—
'a Type of Protect/Activity /. E'--s..L V re e se�5 -6"""_ / /
st le IA p ak.ti.rweyi i�lest G,:t....,i/A e b'd"✓X//S�: /'30 )
1 Per(dock)length
Fixed Platformis)
w P Floating PlxlwmUl .._, r � �r� '"
('\� Finger pier(s)
v rem lens h /
L__
n� BuIk1R'eQr P W"+P length 60' , I /� !
ul erg distance offshore P-e-e
(A rr
max distance offshore /� - j�a__
Basin,channel e)(r+ 4 GQ,/
ddigV
y .___9) ,
cubic yards '
Boat ramp ,_ - - _ �V 9 t Kr Si- i ./rat.
//'� i Boathouse/Boadih �` 4 19/` B el
,� 11�', Beach Bulldoring — _ a F+a/� a T �e/// _ C.a')r e/i15 ._-..__._ -
aher ------
4
•
t Shoreline Length _2 i _
SAV. not sure yes
F Moratorium gMoratoriumNa yes
Photos. yes I I
Waiver Attached. es - - - -- - - -- -- ---
//1
A building permit may be required by: yt 4.etf (i7 See note on back regarding River Balm rules.
(NoteNotes/
Local Planning Conditions
Jurisdiction) p ,� `�.
Notes/Special Conditions ..�-x t+��f/'i Sf4i :-).fic/u,t a
al T orb- /y1-or�l � �
Appkant Pnnte�Naye� .sue �y Pe t icer'a ---
Volga `ya�`� //Lv 7�L —
Volge Please re compliance statement on back ofpertnitee a/
_ / o C7
y i/k fel' J 7 — FtH 2�/202-t -- Ay z7_1[9,zo?,/
t /WPlianon ee(s) Check# 464,1Date yEMenDate

ROY COOPER
Cermet
MICHAEL S.REGAN
Unwary
Coastal Management BRAXTON DAVIS
ry JNVINGNMENTAIOVAIITY aa'Kad
BUFFER AUTHORIZATION CERTIFICATE FOR SHOREUNE STABIUZA11ON
A riparian buffer authorization Is required for shoreline stabilization activities within the Neuse and Tar Pamlico River
basins per Division of Water Resources(DWR)regulations 15A NCAC 02B.0233 and 0259. The Division of Coastal
Management(0CM)through a Memorandum of Understanding with the Division of Water Resources(DWR)has
reviewed your project proposal and has determined that the project as proposed complies with the aforementioned
regulations.
Those activities covered by your Coastal Area Management Act(CAMA)permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below.Failure to
comply with this Buffer Authorization may subject the property owner and the party(contractor)performing the
construction and/or land clearing to a civil penalty by DWR of up to 525,000 per day per violation.
L Impacts: Impacts to woody vegetation from clearing and filling in Zone 1(begins at the most landward of either
normal water line(NWL)or normal high water line(NHWL)and extends 30 feet landward)shall be minimized to
what must be impacted for the sound installation of the shoreline stabilization project. Unnecessary clearing and
filling in the buffer is a violation of the riparian buffer rules.
z. Clearing&Grading:Clearing and grading of Zone 2(begins at the landward edge of Zone 1 and extends 20 feet
landward)is allowed provided that it is re-vegetated immediately and Zone 1 is not compromised,which includes
maintaining diffused(non-channelized)flow of storm water runoff through the buffer.
Construction Corridors:Construction corridors are allowed for shoreline stabilization projects,but they must be
satisfactorily restored as described in condition 5 below.
a Potential Overwash:For vertical shoreline stabilization projects(bulkheads)only;sites where wave overwash Is
expected to be severe,the first ten(10)feet landward(unless specifically authorized otherwise by DCM)from the
structure may be maintained as a stable lawn in order to provide for structural stability.
s. Temporary Stabilization.Immediately post-construction,bare soils must be stabilized as quickly as possible by
providing a temporary ground cover. Newly seeded areas should be protected with mulch and/or erosion matting.
This ground cover is a temporary measure used to address erosion until site restoration can be accomplished.
c Site Restoration:At minimum,pre-project site conditions must be re-established.A site that was wooded prior to
this shoreline stabilization project must be restored with woody vegetation at a stem density of 260 stems per acre.
Non wooded sites may be re-vegetated with woody vegetation.Restoration must be completed by the first
subsequent planting season(November 1 through March 30)after completion of the bulkhead.
a Pre-project site conditions: _
r Project Drawing:The drawing on the CAMA General Permit is considered the protect drawing of your property
indicating the location of the shoreline stabilization structure and any associated clearing,grading,and construction
corridors.This drawing will be used to aid in compliance and monitoring efforts.
By your signature below you agree to be held responsible for meeting all of the above listed conditions and verily that all
inf rmation is coin ere and accurate.
o r� 9✓
'or App scant Printed Name Permit Officer's Signature
Agent
or pplican s nature Issue Date
�./r9
CAMA GENERAL PERMIT It: l (10�7
sum at North Carolina I:nNrairental.Zualhy I Coastal Management
Washington Office 1943 wauww i.i&lua,e mall Washmgtun.NC 171e91252 946-6491
Wiimnwnn Office I I*rardenav,*e E. NC 21 e5.3cia,71C.•ot:.71
s6nehead City Office 400 Conlnerce rAwnue 5l.rehe,id Ciry NC 2a557 12s iiO6-5 Ou

LAMA / -_ DREDGE & FILL N° 79037 A C D
EN ERAL PERMIT Previous permit# /UP-
JC ew ❑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 74 ' //00
Rules attached.
Applicant Name �CC i'vncL.v.. Project Location: County 'P�r�
Address r` C G 3-71 a-3 j Street Address/State Road/Lot#(s) ; / /U,.,1 _
City _ ( ik - State A- --ZIP �S.SiO V'/Iti r.. -
Phone#(Z�) -2/E-Mail 7-ILYAe ea-^/''s.,i ems Subdivision (�
o.Csw,
Authorized Agent - City ZIP 2-8 S/ice
Affected ❑CW rEW JpTA ES ' i'TS Phone# (,2 (7S• 9/2--- River Basin N�a4 _
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA N/A Adj.Wtr. Body �c�c_-s-t 60 yt1i-- natj/ n /unkn)
❑ PWS:
ORW: yes :� PNA yes / Closest Maj.Wtr. Body N' -(- A'i(J _
Type of Project/Activity 4p 4 Letti L i�r--1) 5 -1b ✓"�� Coo/
dalkafteeiGeitige �Q,1ol.(p We wvr-1 i S,n-L a/fnr,,t:.f1,4 Oil d`✓JkScaie: /'Yo )
Pier(dock)length
zil - i r- I 1
Fixed Platform(s) 1 • �� I ' eet�� 1 , �,
Floating Platform(s) i I
.
Finger pier(s) t I _
Groin le
number ! Ir I i .
t I
Bul Ripra length ( i
avg distance offshore , � ,IP
�'
/O {
max distance offshore- I I j/
Basin,channel /
� i II
ig A , ,
1 Pf fc).--
cubic yards T:::::
,,,,-Boatlift I - - -- " _ `-
1 ,
i
l'AMPillBeach Bulldozing 1 •■ 1
Other ; ji
V/�/pj
ate ., . }'
Shoreline Length l iI
i
SAV: not sure yes no -
Moratorium: n/a yes (i ! I 1 _
_ rt_ r
1
Photos: yes f , , , : ; : :
Waiver Attached: I I I . ' I
A building permit may be required by: �v1yt I . [ See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) Pry /� /
Notes/Special Conditions lil�. , —./ Gl1/ �C/Sken_5 `v�i t( cA,t,te,
/ i I ay._
f\gent or Applicant Printed Name Permit 0 leer's Pr d
Signasyre *'"Please read compliance statement on back of permit*-'" Si at
7,4 f�' 379.7 ',PIr 2-4 20z4 - 1/4ty 2.1 i
plication ee(s) Check# Issuing Date piration 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(910-796-72 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

0 CAMA / DREDGE & FILL N° 79037 A 1 C D
GENERAL PERMIT Previous permit# �/�
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued f60
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 15A NCAC 7 f!/
' //OD
{Rules attached.
Applicant Name f (� c:Tc"A, �Y�'D i-V' Q Project Location: County r7 a
Address r"e C) /(>3 y/ 2-3 I Street Address/State Road/Lot#(s) C9 / /tom
ac______
City /I.-a r k4- {-- State Ne ZIP - S/Cu /,"i/�
71
Phone#( 52- ) 6--A- .//2%E-Mail •`,;yet re) '(.:,- b' R itd-4,d_` Subdivision
Authorized Agent �(ooi City L -),,^ ---t_. ZIP Z , ' C./C
Affected ❑CW ®EW Ip.P T A NES I'OTS Phone# (2 6,75 9 Z 71 River Basin /V.u- �-L_
AEC(s): ❑oEA ❑HHF ❑IH ❑UBA ❑WA Adj.Wtr. Body /V., -Si Jg V Or nat /ry'an /unkn)
❑ PWS: A,),.e.c:c.. C I u-(---
ORW: yes / no PNA yes / > Closest Maj.Wtr. Body
Type of Project/Activity
/ )- - (-4 �'�//
' _., '.'ti✓ ,✓0 A O (IG Ft.IG�G)01 2:' �� C- a/7., , I A"c ) L-� Z ,c Scale: /'30 )
Pier(dock)length J
Fixed Platform(s) i
Floating Platform(s) I �j. �/•- t' ' r I
Finger pier(s) i imIIF
Nu r
Groin length
number
Bulkhead/Riprap length �/ ■ii � ..-- .■�.avg distance offshore / ■ �• ■•■m • •■■■■
max distance offshore 'i I ,",,,, �,,,��, ,,,,,,
Basin,channel : 1 + ' i
cubic yards1111,‘ p„
,,..,,s,ive , ...,.. •-_ , ,
Boat ramp Jib 1:' 't!�, K�� ''Boathouse/Boatlift 111111 ja. ........ .; - i..................
El
1
1
Beach Bulldozing • � �■■■■■■■�• �•�■•■■■�
i
Other � i � I f i,� MIII i : -
iiii■■iiii�ompoi ii■i� ' iiiii■i
s I I , i
Shoreline Length �j •H1Pfl
1 111111. _13
Moratorium: n/a yes 11
i
Photos: yes ' i Il iiiiii ,
Waiver Attached: yes nn :
A building permit may be required by: i to c.c9 ( r) , . Y'See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) Pry
/' ..
Notes/Special Conditions , ,,, , � 'EX./�/ 3 /,.�,4 fic `ix.,,,,
AAJ 9 -
Agent or Applicant Printed Name Permit icer's Pr
V
Sig re Please read compliance statement on back of permit'
WSi at 7
fi/P
plication l"de(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 (252-946-648 I) 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 252-946-6481
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

erEli CAMA/ ❑DREDGE & FILL N° 79037 AB -, CD
GENERAL PERMIT Previous permit#
> L 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 5A NCAC 7/7 , //o
I7Rules attached.
Applicant Name Project Location: County , -
Address i , < -' .ii =,"/ - Street Address/State Road/Lot#(s) ,
City , (.<'._ i''---(- State ZIP • -
Phone#( ) ' —7 . " E-Mail Subdivision •
Authorized Agent ------- ------- ----- City ..�'--�--c ZIP ' /{J
❑CW 'PEW ❑PTA ['ES is PTS Phone# ( ) , I `" 4Z•y River Basin /1,`f' e_.
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body /C' ,- — ' .' , (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no '
Closest Maj.Wtr. Body
Type of Project/Activity
i 1 (Scale: -),D )
Pier(dock)length
i ( 1
Fixed Platform(s)
I
Floating Platform(s) 1 I 1 i i +
Finger pier(s) I i i t } �_4 /
Groin length i I 1 I I
number _ i — --.._..- j._....—. -.._.._i l
Bulkhead/Riprap length L7[• - _...........-._.. 1.-._ ...._.____ 1— -
_...__ P P St i
1 I I. i
avg distance offshore ,gr�/(, j I7
�� i
C
Basin,channel i + -
cubic yards ,i47,
�j .� '). 1
Boat ramp 1 �r j a t<(Xf:T �0_ - .'.L t`..% r
Boathouse/Boatliftf �,f
1 l i
Beach Bulldozing
rL, r: /. nf`� J i� —
� I Ii( I ('. .''' ---�
f I 1
Other A I i i '
�'� ), Pa r j 'F 't - � 'p� f
Shoreline Length . / 1
I
l t i
SAV: not sure yes no j 1 -
1 ............_...-____..__.__...._......_...._......__..--------• ._......_ ......_._ _..._................._.......------._._.._. _._........ - --- ..........._..__._-- _.____...._......._.._..
, -
Moratorium: n/a yes no' -❑ 7{ ' I
Photos: yes f
I
� I
Waiver Attached: ye --,)s- � _._i
A building permit may be required by: /,,� ('ter. Cr, , . ( See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) I +:i. •') /
Notes/Special Conditions -;'1 V - /c -- y':
r
4,, t I,,,`a..-
Agent or Applicant Printed Name PermitONcer's Prjattd '
/,
Signature *le Please read compliance statement on back of permit** Si atu
g / �� yea 379'7 ;�, �-1/ t-'z I ���1,q y Z C ;
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.
e esou ces. Contact the Division of Water Resources at the Washington Regional Office (252-946-648 I) or the
Wilmington Regional Office I 0-796-72 15 for more information on how to comply with these buffer rules.
g g (9 ) p y b e es
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
252-264-390 I 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

UntY
f, . 1 I pass Flora Moorman <[e-mail]>
Flora Moorman 591 Neuse Village Road
2 messages
Flora Moorman <[e-mail]> Fri, Jan 22, 2021 at 4:08 PM
To: [e-mail]
Kent:
These are the two adjacent individuals who had to sign the riparian forms.
Also attached is a COPY of the old permit.
Thanks for all your help. Check on the way too.
My Best
Flora M
2 attachments
1_ ;. lift 20210122160642208_0002.jpg
#ll i 4- 448K
20210122160642208_0001.jpg
436K

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT , 7
I hereby certify that I own property djacent to ! 0 rA '�� ( i71Ih it)
V 's
(N me of Property Owner)
located at l , v ( l�
property J � �� q �
on-71pp � '� se 1 l�,e r (Address, Lot, Block, Road, etc.�-C/V� " , in f-r -- hog ,j/' arnpite.
, N.C.
(Waterbody) I (CityIT�wn 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)
j t
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 the appropriate blank below.)
XdoI15'
wish to waive the setback requirement.
I do not wish to waive the 15'setback requirement.
(Pro r y Ow er Information) (Adjacent Property Owner Information)
ure ken( Si ��ua vn k.-e- I ,c-VA
Ply t Tyne ame Print or Type Name
au .) 3/ ?o Bax Isis
Ma ng Add ess 2 ./ Mat ng Addresis
fV vl !�S/� A a nl ZgSla
ity/ tat p7 City/State/Zip
S' 252— G 70 — if
Telephone Number/email address Telephone Number/email address
zo121
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to v 1 .7, /14 0or 's
(Name of roperty Owner)
property located at /7 N.)cam_ �'.1 Io�t e f
(Address, Lot, Block, Road, e�tc.)
on ;Jc A^5e. , in I�-rZ- '� � L , N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
Y- -€1 - _ +-gyp'
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
e. (If you wish to waive the setback, you must initial the appropriate blank below.)
Kk I do wish to waive the 15' setback requirement.
I do not wish to waive the 15'setback requirement.
(Plr Owner Inf mation) (Adjacent Property Owner Information)
Si came ature* _
. orr� ) �1d rm/ )� -�u.w. 04
Pdnt or rye Name Print or Type Name
pD 001, 0? 3/ o 5
!tipping Addres �i �/ MailingAddres
" 1-07 !WI
l�/�t" S art �C z Ors" 7/
City 2 _7*4 City/State/Zip
Telephone Nu ber/email address Telephone Number/email address
7?-20 21
Date / Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

PSICAMA/ ❑DREDGE & FILL FIocc0 :`-� A B D
ENERAL PERMIT Previous permit#
;Kew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality ',r n��
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC O7 f 2
p/�
Rules attached.
Applicant Name F[Oca MCOI N a n Project Location: County fang//(-O
Address Po Box I �- Street Address/State Road/Lot#(s),r •
City A�'(. PAVIO StateN C ZIP�Ij p.570
Phone#( �)!n15•94Ll� E-Mail Subdivision
Authorized Agent — City Z
� IP n/
Affected ❑CW DEW ❑PTA > ES ❑PTS Phone# ( ) River Basinc /V e &se
AEC(s): D oEA ❑HHF ❑IH ❑UBA ❑N/A !Adj.Wtr.Body V eL(S w1 C,R/ /man / nkn)
❑PWS: p
Closest Maj.Wtr.Body I'aM(► CO OWd.
ORW: yes / "P PNA yes ,®
Type of Project/Activity % Se� UI!!V b
II I
(Scale:' i/a )
...IPier(dock)length ' i 1111 I i I I 1-1-1
i I ■E
Fixed Platform(s) i ••
Floating Platform(s) Li MIMI ��_NEUB ��
Finger pier(s) !
Groin length
i I ! M.—. III .
j MEI number . I !I
ar"Prep length Go I I Q I I , I I
avg distance offshore SIP I I - i 'i I
max distance offshore I —I I 1 0.1... I I } I I I
I
Basin,channel / I I I ! I I I I I I�
llicubic yards I 1 1 M I V ,\jl \y ,�IC
Boat ramp Ell
, IaaU .� I , ■■ ■ ■.
Boathouse/Boatlift ■�
iHuiI� lII1 INiII' 4IN a I
Beach Bulldozing ' ■.■.U••••••■■■■■=■ L_ ' I_ j
Other , IIIH'�■Ii
/ ,L R� •. UIU• IIIII■■ 1111 I I •UUUL 1 , ME■
�dr��
Shoreline Length 5 7 I.. 1 i I ITMAI i I i,Ii,�i • j '
SAV: not sure yes • IV ��J r 6 .. k' DAI.a 0,--- „ 1p'
■ivau � M
Moratorium: n/a yes 11 u j UPI I I ��' �� (—
Photos: yes I I K�I� i I .i� II �+i u� ��� ..( •.
Waiver Attached: yes I • -- '
A building permit may be required by: (:)CI r 11 ICE CO tAr See note on back regarding River Basin rules.
( e
Note Local PlanningJurisdiction —
Notes/Special Conditions
S1-I)V I'1 "F�`f-1rin art e.1-1 s,0-11t5,
lI ik AA . F` 6111119df
Agent• �� ,y�' ed :•�e PermitONG er s Printed Name
Signjil re ' `Please read compliance statement on back of permit" Signa �e
3
st 0 1. ' !) 19 __
Appli�tion Fee(s) Check# lss ng D e x ration to