Woody, Myron 77193C

RCAMA / � DREDGE a FILL Nn 77193 A B CO D
ENERAL 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 I SA NCAC tiles attached.
Applicant a Project Location: County��
Address_ Street Address) State Road/ Lot #(s)
City State ziP0776
Subdivision
Phone # ) ✓�✓I E-Mall _ ziP.
Authorized Agent � //I P. n s — City_ 4l River Basin
Affected"� ' 'BRA ❑PTS Phone# (_)
AEC(s): ooeA ❑HHF ❑IH ❑UBA 7N/A Adj. Wtr. Body n1eW Kl yia: n t an u kn
❑ PWS: ��
ORW: yes no PNA yes/ no Closest Maj. Wtr. Body_
Type of Project/ Activity
Pier (dock) length __ — -
Fixed Platforms) 1111ILZt
r - -
r (—
FloatingPladorm(s) .
Finger pier(s)
Groin length ---- ---- ----- - -
number
i
Bulkhead/ Riprap length-
_-
avgdistanceoffshore
max distance offshore. —
Basin, channel
cubic yards
Boat ram
Boathouse) Boadif _ I
Beach Bulldozingl
Other __$��t _ : I
Shoreline Length
t—{
SAV: not sure yes
'~•
Moratorium: n/a yes
�_
Photos: yes I
'._.I
Waiver Attached: y�e % no L L_
_
A building permit may be required by:
( Note Local Planning Jurisdiction)
t//04
Notes/ Special Conditions
n �
(Scale: ! / A )
' I
❑ See note on back regarding River Basin rules.
Feels) i Check#

CAMA / ❑ DREDGE & FILL O
.., N . 77193 A B © D
ENERAL 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 I SA NCAC .
ules attached.
Applicant a Project Location: County 0p ,(01A1
Address Street Address/ State Road/ Lot #(s)
n r_ 1 A l ZIP n
State
Phone # W) j- 2_ E-Mail
Authorized Agent &tui& M4 In e. GVA Of
W �W ,NPTA ❑ PTS
Affected AEC(s): OEA OHHF ❑ IH ❑ UBA ❑ WA
❑ PWS: _
C RW: yes / no PNA ! \ yes // no
Type of Project/ Activity �
er
Fixed Platform(th
Fined Platform(s) it
i
Floating Platform(s)
Finger piers) ^�
Groin length i
number
Bulkhead/ Ripmp length
avg distance offshore
max distance offshore
Basin, channel 14
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach
Other
Shoreline Length `(-/—
I
i
SAV: not sure yes no
Moratorium: n/a yes
Photos: yes
Waiver Attached: no
A building permit may be required by:
80
( Note Local Planning Jurisdiction) , /
Notes/ Special Conditions ,l/
Jwrrl 5; 7E
�991t or Applicant Printed Name
F
lignature **Please read compliance statement on
back of permit**
t ano,°°
3587
4pplication Fee(s)
Check #
Subdivision 0 0 A.
City Olt ZIP �J�
Phone # ( ) River Basin �/ 44
Adj. Wtr. Body n t an unkn
Closest Maj. Wtr. Body S 61 P S Bu
PermitOfflcer's
(Scale: rs � 7i
)
❑ 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 howto complywith 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

nA
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C Ate
CDC
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to ! YI 1)'C f� e C AV s
r (Name of Property OVVnier)
property located at Ln obi im �l 4 of
ddrasa', t.ot, 810 k, Road, etg. j
on �LM L_j_ . \! Jn , �a . 617 Vl � E - On5 uJ, N.C.
T(Waterbody) I (City[Town and/or County)
The appl'cant has described to me, as shown below, the development proposed at the above
i nnn
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 to description below or attach a site drawing)
AIVER BE
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. u 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`
fie.
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e pp
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or7yyp� Na
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cry/st"ZIp ayy,.ii
Telephone Number ernsy address
tr'� aQi o9Ga70
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 W I hereby certify that I own property adjacent to 1 re {%G J 's
h /I j"ame of Property er)
property located at oZ l✓ l._✓Q G t am Lci— h p
ddress, Lot, Block, Road, etr, t
on bziqunU �i in J0cVk5 60VL'1Ie- -� 51aul,N.C.
(Waterbody) (City/Town and/or County)
t1 �' The tapplicant 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or aftacif a site drawing)
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.)
1 I do wish to waive the 15' setback requirement.
l 1 I do not h t
C"�'JC'
wis o waive the 15 setback requirement.
�Fs�?f.�priitEYrla�'+natisn? :.��
Signa u
e s 3 v ce (k, Qje�
Print or Typel�ame
�Co'7 /'�1,�.-Tom (',I
Mg1(tt7gApdress
<sow✓�I%L /UC SRO
—/S .>W
—1C�-O�-Ldo_ ----
Date °
'Valid for one calendar year after signature" (Revised Aug. 2014)

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Page 1 of 1
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
Mailing Address: Q d AlR
Phone Number: 41111 - 11 M - 1?6i I
Email Address: Myun-IUPP.,%^%a UGhtil).GO
I certify that I have authorized L— n n e fit NI aYl /1 P (n
gent l Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: lo'tl a' /fo d0 ck /r%4rX T f
0ie.r %I�1 //--
at my property located at C 4 ✓1aU i)Ct h P , (jack,'TAt1Vi l l
ORWIT01161[l�1
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management stall, 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 Info t lion:
77 Signature
Myron Wo dy
/�
Print or Type Name
Ot-o Pr
Title
i5/11 /20?0
Date
This certification is valid through
https:Hmail.google.coin/mail/u/0/?tab=wm 5/11/2020

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