Marble, Jason 77340C

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Aew ❑Modification ❑Complete Reissue El Partial Reissue
As -authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environrpental concern pursuant to
Applicant Name
Address,) �' �. n C ✓ ' / - V/
City r ( State /-�- ZIP ,f }
Phone # O ( - r. 7
E-Mail
Authorized Agent
Affected ❑CW CEW ..,ePTA DES ❑PTS
: OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
AEC(s
❑ PWS:
ORW: yes / no PNA yes)no
N9 77340 A B C :, D
Previous permit #
Date previous permit issued
15A NCAC _7
❑Rules,Attached.
Project Location: County A, L
Street Address/ State Road/ Lot #(s)
Subdivision .
City / ,., " r, ' ZIP
Phone # (_) River Basin /� 10'
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Agent or Applicant Printed Name
Signature *' Please read compliance statementon backof permit"
Application Fee(s) Check#

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 1) 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, certifythatthis project is consistentwith 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 (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: .iaSon Mar b\c,
Mailing Address:
Phone Number: 3 '� to ' 4r S - 3 S °12
I certify that I have authorized
V
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Gor) S-�'ry G-h (Dr) Q-F Q
new Conere�e dock
at my property located at 2— q w i nd i ng r,r Ce k W o1 J ,
in o r) SI aw County.
I furthermore certify that f 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.
1' Signature
jasor,\ may ble
Print or Type Name
Title
I l
Date
This certification is valid through f /

I hereby certify that I own property
property located at 2"1W n
on , QU P.PnS creep
(Waterbody)
to Jason Marble _'S
(Name of property Owner)
ss, Lot, Block, Road, etc.)
in SWAr,SborQzonS10VV , N.C.
(Chy/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loon.
c �� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/ORDRAWING OF PROPOSED DEVELOPMENT
(individual proposing developmentlmust fill in description below or attach a site drawing)
see o,�te ed dra,wlr,c�
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.)
11 1 do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.
Owner Information)
rnnr or type ivame
21`F wirylinA GreCK wad recgc)i
Mailing Address
huber-�-,nG 285321
City/State/Zip
a3�o - 45 S - 3 8°l 2
Telephone Number/email address
Date
(Adjacent Property Owner Information)
/(%w,'�,G, ,
mgnatr e*
Nolan or 0rer,den SKIdrnOYe
Print or Type Name
200 Gertrude �AUr Gt
Mailing Address
SwanSbOYO. tJG 2't'�54��
City/statemp
Tele one Nur�er/gmail qddress
�b a- 7 sg
Date* / 2- ! n- -;Z
(Revised Aug. 2014)
"Valid for one calendar year after signature*
112

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..... . ........ . .. . . ........ ... ...

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that l own property adjacent to Jcisari Moy bl e Is
I (Name of Property Owner)
property located at 2 wtn \ Grf-e v fa
(Address, Lot, Block, Road, etc.)
on Q u P.2.r15 Gref.K I in Swans; bQ`r0 / rNsovv N.C.
(Waterbody) I (— City/T� and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I
I have no objection to his proposal.
I have objections to this proposal.
DESCRIPTION AND/O DRAWING OF PROPOSED DEVELOPMENT
(individual proposing developmen inWdfilLin description below or afiach a site drawing)
see o coach cky-onw't �q
WAIVER SECTION
I understand that a pier, dock, moodhg 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.)
i I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property
yOwner Information) (Adjacent Property Owner Infor ation)
�I� oci M�rh\e Wichaej or .10 ann WPVC
Print or Type Name Print or Type Name
171� w n�a er2CK JVa�_ 5409 rnaS5eha111 Gt
Mailing Address Mailing Address
h.1OPY4'lnG 2a53©1 GG1arner,NG 2.15Z�I
citylstatelzip citylstatelzip
3Zko - 45 5 - 3S9 2.
Telephone Number/email address Telephone Numberlemail address
? -� �
Date Date' �-�' 7 `e
(Revised Aug. 2014)
"Valid for one calendar year after signature'
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