Parks, Clinton 77182C

yCCAMA / DREDGE & FILL N9 77182 A B Q' D
ENERAL PERMIT Previous permit #
New Modification Complete Reissue ;Partial Reissue Date previous permit issued __.-
As authonzed by the State of North Carolina, Department of Environmental Quality �/ �^
and the Coastal Resources Cm mission in an area of environmental concern pursuant to I $A NCAC B fT . I9q _
anached
Applicant Name �la�_^---
C I I Y�� S Pr
oject roject Location: County ®/)��O L✓
Address I'f7 ��ct n uAA bA� �( I�� Street Address/ Sate Roadl Lot #(s)
y,'TatOr
Citv;llle StateNC ZIP' ,�fo
Phone# (91�)J7✓' 7t�O E-Mail ./ Subdivision %
Authorized Agent Ennef I nG Cn/�Sy'nae�f'/ O� City µ ' ZIP _
Affected CW �W .f'fTA ES PTS Phone # ( ) River Basin Q
AEC(s): OEA HHF iH USA NA
PWS._ Adj. Wtr. Body New i VQ,�_ Co /man /unkn)
ORW: yes /6o PNA C>p / no Closest Mal. Wtr. Body e.*V PI- ✓e-fi
Type of Project/ Activity
Pwr (dock) length f
Fixed Platforms)
Flostxng Platform(sl
Finger pwr(s)
Grwn length _
nv be.
Bulkhead/ P,"p length /
aq dnunce offshore _
m duriarueeffshwe j
eas'n. charnel
tubic ye& .
Ile
Boat � Boatf
J 3 _x13'
Beach WldoaingOLVW
Shoreluw Length J ,J
SAV: not sure yes
MomtorWmNa yes
Photos: yes
iv.. ^� ®los Waer Attached: ro .. I
A building permit may be required by: 0 $6 (j
( Note Local Planning Jurisdiction)
Notes/ Special Conditions NA-F —fL e PV r'001
` IM ' Qn
loin MAIM Nanse
Sign uw "PLC r tpfiance statement on back ofpermit e'
M. 535�
Appixarron Fee(, - Check
(sale:
N
U
See note on back regarding River Basin rules.
PnmaOHKa
Sig a
ITSU ng ail` ap,l. on Date

OCAMA / ❑ DREDGE & FILL ���
N9 77182 A B � D
.
"GENERAL PERMIT Previous permit#
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 15A NCAC 6 1 if • I 0
/ '/ M Rules attached.
Applicant Name (�I I Y1 n F" �fps Project Location: County (04,510 VA/
Address Street Address/ State Road/ Lot #(s)
City I State nIG ZIP �5�(� ,I�
Phone # (�) % ' S E-Mail Subdivision La.A L�4gt h&,y
Authorized Agent EnnPll���/X�1/)G �!1$ itn/�(O/� Cityy ZIP
Affected LJCW "i -W +"'A DES ❑PTS Phone# ( ) River Basin Whfi-p-©ak
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj. Wtr. Body /V 2(/f/ V� ) I na /man /unkn
El PWS:
ORW: yes /6) PNA (5�V / no Closest Maj. Wtr. Body
Type of Project/ Activity 4) C0 RQSFJ(h I
Pier (dock) length l
Fixed Platform(s) i/
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length /
avg distance offshore
max distance offshore_��
Basin, channel
Boat ram
Beatho e/ oatlif
I
Beach Bulldozing
Other
Shoreline Length N
SAV: notsure yes /not
Moratorium: n/a yes
Photos: yes CX9vS
Waiver Attached: lv% no
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Special Conditions
reSi*sPeazeread compliance statement back T.) •'"
33' �
Aoolication Fee(s) Check #
(Scale:
H
❑ See note on back regarding River Basin rules.

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, 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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
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
Revised 7/06/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �l/1UY(I� alx/,()?�G
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
l` Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at —L�
in _�J� County.
10,k goad 41a
I furthermore certify that l 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 Infornration:
A IL
Signature
CIAO f Oar Ltx elks
P/9nt ar Type Name
_ tan ffr5
Title
I /6 IZv2-0
Date
This certification is valid through
RECEIVED
OCT 0 2 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY ONER STATEMENT
I hereby certify that I own property adjacent to _adJ( W61J `f-(.0k'uw e, lkil- 's
�/ (t� , of Property Owner)
property located at __j _ IJ Q (f %1!J �/ / X,
pp ,jAddress, Lot, loc , Road, etc.
on t?(1�'C1j'lPr' in c 11 nhItIIP ,N.C.
Th,- aant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
� ne
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fit/ in description below or attach a site drawing)
WAIVER �.CT�Oy
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. (i 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.
`Valid for one calendar year after signature"
��mF y,9n
(Rev]sedltuv_7A1dL_
OCT 02 2020
DCM-MHD CITY

ti.
j
,,,

ADJACENT RIPARIAN PROPEp ry v+r"'"'aR STATEMENT
I hereby certify that I own property adjacent to. Cj/.V km 1r thy`/Au06 4YPc ,s
Property located at ( e of Property Owner)
r ddress, Lot, loc , Road, etc,
on N 2 l (INaterbody) r in N.C.
(Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
t s
I have no objection to this proposal.
ne I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing devetopment must till in description below or att®ch a slte drawing)
WAIVER SEPJ=
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.)
�j 4, ___ I do wish to waive the 1 V setback requirement.
n Q I do not wish to waive the 15' setback requirement.
❑+
`Valid for one calendar year after signature'
(Raiment Property Owner Information)
(Revised Aul�oftIVED
OCT 0 2 2020
DCM-MHD CITY

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