Fulcher, Timothy 76716C

rC�rr� REDGE & FILL G r I C N�T 76716 ��C��
I�tAL PERMIT 1�QPrevi Previous A C-C D
New E)Modification ❑Complete Reissue C1Partial Reissue Date previous /permit issued
As authorized by the State of North Carolina, Department of Environmental Quality -7N
and the Coastal Resources Commission in an area of er,ro mental concern pursuant to I SA NCAC r
I ^ QRuI attach;d.
Applicant Name I (^"' `� C N e:ii' Project Location: County C �'✓ �"•/�
Address ias l t) t Street Address/ State Road/�L7ot #(s
City v 1 // state.A/4CZIP
Phone # G� E-Mall Subdivision
—,� -
Authorized Agent q ---- -- City. a� V ZIP V
Affected OCW DPTA ,,,✓JeS OPTS Phone# (_) /1�t��°,er�_Basi(n r�M
AEC(s): ❑OFA ❑HHF QIH ❑UBA ❑WA Adj. Wtr. Body, /Ci `f"✓ ` n Imanl(un�
�❑ PWS: <J
ORW: fyes f no PNA yes no J Closest Maj. Wtr. Body.—
Type of Project/ Activity
Pier (dock) length___
Fixed Platform(&)
Floating Platform(s) _
Finger pier(s) ._
Groin length
number
Bulkhead/ Poprap length,_ _ __-
avg distance offshore
max distance offshore,
(Scale: n j )
1 i
I i 1
Basin, channel _ i I s J /
Boat ramcubicp
f b I t�v't- �?�-t� /Q U GG7 _7f 1'{%t't i11 zt-l-�
Boathouse/ BoadiR ... �/- 1O
0 'LJ i�C'a(/!4e/ V. U C%I C e �t CC✓lilr°�hlr�
Beach Bulldozing____
Other
CY ec,y G�)i
- I
Shoreline Length
SAV: not sure yes no
Cv,,,{{{�,y� ij�
Moratorium: n/a Yes no �/ �Zo f�G t� �.� 1=`t'►Ni r(iVr�j •ff��c�`✓
Photos: es no
Waiver Attached: yes no
A building permit may be required by: Cv f �r�e ❑ See note on back regarding River Basin rules.
( Note Local Planningjurisdiction)
Notes/ Special Conditions
- -� -- - -
t or Applicant Pri e
Sign a r'r"Pleasereadcompliance statementon back ofperml 'ss"
Cn
- Expirationr�� _

AMIA•rr�REDGE & FILL rJG j G N° 76716 A D
NEIi�AL PERMIT Previous permit#
eW ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality / H ' I /S`P-
and the Coastal Resources Commission in an area of epviro mental concern pursuant to I SA NCAC / J _
r❑Rulgs attachpi,d.
Applicant Name T t f"` t^' C Project Location: County �'Y �i✓�
Address f +J t 7c� Street Address/ State Road/ Loot #(s
City D } v 1) State ✓��ZIP , c / l� UJ ��
19IT•7iLa
Authorized Agent
14° ' E-Mail
Affected ❑ CW 17�w ❑ PTA .B CS ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes no PNA yes noJ
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boadift
Beach
Subdivision
city �J/�1 vl� zIP l
Phone # ( ) Iver Basin t M
Adj. Wtr. Body l/V K IU`'f nat man unkn
Closest Maj. Wt.. B_d, �G ✓ c (J ^a
Other
C:yPr) G7L��liC�C
1�
Shoreline Length
SAV: not sure yes no i
Moratorium: n/a yes no f�C'7 I �)' / o I,r �� if �•%� i' c'1 {��'
Photos. yes no _ _ /,
Jt
Waiver Attached: yes no �4•�f� t
A building permit may be required by:� �v' f �r`�c ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
c2 0/MV-PU ,I`
Agent or Applicant Printed Name
Sign re �' Please read compliance statement on back o(permi '**
App ication Fee(s) eck #
`1/0
Expiration

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, 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/ 1-8884RCOAST
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

NC Division of Coastal Management
Hurricane Replacemcnt/Repair Request Form
Date of Request: 20
Property Owner
Address of Propi
Telephone Number: re r - 1$ 4 V
Type of Work:
NOTE:
• The Emergency CAMA General Permit 2500 is for repairs and replacement of water -
dependent structures damaged because of a Hurricane. The replacement, reconstruction
and maintenance excavation activities shall conform to current standards and rules. All
work under the Emergency CAMA GP 2500 must be made in the same footprint of the
previous structure with no additions, expansions, or enlargements.
If any portion of a structure being replaced is within the 15' setback of the riparian line or
access area, signatures of the adjacent riparian property owner(s) must be obtained
acknowledging the notification and waiver of the setback on the forms provided by
DCM.
• Any maintenance excavation or dredging requires signatures of the adjacent riparian
property owner(s) on the notification forms provided by DCM.
Signature:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I V14f; r 11 U t-u—tn-koffs
Na of Property Owner)
property located at UIS
(Address, Lo lock, Road, etc.)
on < (Q:L c �C� 6 � in a t S N.C.
(Waterbody) (CitytTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
y_ I have no objection to this proposal.
I have- -Qlijaolion___s o-this_prap_osat— _ _-__-.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing deV—elop—m-6ntVust fill in description below or aftach a site drawing)
diq oPt7ax' l0 0 �(on,s
idw
ctrr6r a73 JV3
oto ep
' 4 oo 6,0 Ov� ct
10Pe7� x %Yac
10
3'
of f � 5.
i Nnk
' W rtG°�' WAIVER SECTION.
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or
back a minimum distance of 15' from my area of riparian access unless wain
wish to waive the setback, you must initial the appropriate blank below.)
U/ C I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback requirement.
(Property Owner Information)
mature
M j i
Print or T e Name
ae71 kr#fa &"'J-eh L�,e
Maifina Address
in m+ be set
by m . (if you
(Adjacent Property Owner Information)
A I , . _
Pnn orTypeN me
200 ��e('(f��r-
M ' i/pg Address pp / q
telephone Number
AY44A AM. -2.1 . 20
a
(Revised 6118&012)
C

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ) i vm/T1 (-wiCAwX s
of Property Owner)
property located at ,2 l Na
Ul5
(ddress, L lock, Road, etc.)
on (111 f &04 in ' If (S N.C. .
- (Waterbody) (Citylrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
71tion
I have no objection to this proposal.
have obieclioxts_to_thisr pD2.aL___
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing de elop ust fill in description below or attach a site drawing)
otl9 ,PPA,'10R5 .
>� idw rib
crrr%=
doer
fi
1-iow6ote at-vt
,,U prep N "mi l CX✓�><
Cf,l � �$
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or
back a minimum distance of 15' from my area of riparian access unless wai
wish to waive the setback, you must initial the appropriate blank below.)
c?�1 ` I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback req uirement.
(Property Owner Information)
in m be set
by m . (if you
(Adjacent Property Owner Information)
fQfinature
Prim Type Name P
.I)A 0 .1i-lvo Oct
Telephone Number
Zs-.)-- z 4 / - / I? ��S
20
(Revised 6116/2012)

AGENT AUTHORIZATIONFOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit kl e)r—
Mailing Address: '
Phone Number: y S1e0
Email Address:
I certify that I have authorized ;,�}
qlc eltt/ onvac_
to act on my behalf, forihe.purpose of applying for and obtaining all CAMA permits.
necessary for the following proposgd,devetopment: r
at my property located
t furthermore certify that / am :aWhortzed to grenf,, and do In .fact grant permission to
Division of Goastal Manggement.staft, the Local Permit 0fricerand their agents to enter
on the aforementioned lands in connection With evaluating information related to this
permit application.
Property Owner information,
Signature i r/
forType Name
Title.. .
Date
This certification is valid through �J t 7. I