78047A_Martin, Wendy & Ellis, Robert_20210311

ElCAMA / '::1 DREDGE & FILL N9 70047 A B Q C D
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GENERAL PERMIT Previous permit#
—:New 7]Modification []Complete Reissue El 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
❑ Rules attached.
Applicant Name Wee\ '! _, WCkr l'tf-\ f Ku
Address i0, ' O %Par' ((A )r11F
City nor a r % State `3 C ZIP �q 5 ­ I
Phone# (. ) k' f 1 -(6rl(- E-Mail wP vh .-j (?Corhel1 •rr
Authorized Agent -Tr-c"y , S LAI, ,
Affected ❑ CW ❑ EW ® PTA 4 ES © PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ElUBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no)
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/'Boatlift U
Beach Bulldozing
Other
Project Location: County
Street Address/ State Road/ Lot #(s) j' j 1 15
Subdivision G Gf ��PGc41
ZIP fi% 9 j2
Phone # ( ) River Basin 0 H C "- ri "
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: {
Now"
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■■ Jim
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I
Nil ■�, M i��i '
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
PermitOff7cer's Printed Name
1'� f
Signature
J111l z '/tf /z/
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 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 252-946-6481
Fax: [phone] 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)
(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 FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: f i
Mailing address: 3 l
N
Telephone Number: _ 4 11 06 _ Z79 - (0 5-i (c
I certify that I have authorized _ �" Ajts L LL-
`( (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
a.� ► -fin; � .�
at my property located at
This certification is valid through
(Property Owner info
Print or Type Name
Title, co. owner or trustee for property
Z( 14
(
Date
&()� - a�g- &s'i('
Telephone Number
1 2y►'�� CGcv\tle6� c3
Email Address
AEA-,� CFAA C�
(date).

ADJACENT RIPARIAN PROPERTY OWNER`` SppTATEMENT
I hereby certify that I own property adjacent to
Nam
property located at b ,F ��, e of ---Tam� Property der)
on C .. Address, Lot, Block, Road, etc.) _
(Waterbody) , N.C.
(CityfTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
n.
I have no objection to this proposal.
( have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must All in description below or attach a site drawing)
N �\ 13 1-3-
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
FIht or T e Name
Mailing Address
Cd 9WWeMp
Telephone Number/enm# address
Date �+%2 I Z 1
*Valid for one calendar year after signature*
(���+}��Pe�"h�jcaner Information)
S' afore
Py*gt or
22 Type Name j r
vityl
gdres�r .�
n ►L/
te/Zip �9�i
Telephone Number/email address -f
z l0 -7 /zr
Date #
(Revised Aug- 2o14)
1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent toI�Z i J -
os-r�►S s
property located at ?j mew Property Owner)
on�cS�(�� (Address, Lot, Block, Road, in -)
. �U�EN ,
(Waterbody) (City/Town and/or County) N.C.
The applicant has described to me as shown below, the development Proposed location. , � P P Posed 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 attach a site drawing)
\ Val" I � ,1 13 -�- )-->
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
�Np Y Y-AP--T /
Pnnt o Type N me
Marling Address
�DfJ� �(�-�
Cdy/StateMp
Lrsr�'1 —a
Te%phone Number/email address
�/�-�
Date
*Valid for one calendar year after signature*
'A
(Adjacent Property Owner Information)
"L I ���
signaur
�L S \ T LSI..L.l..frL��
Pnnt or IJo pe N me /l i-
42'l
Metl/n Addfess
Cny/State/Zip
Telep Z-f �--
ne N mber/ema►! address
D e#
(Revised Aug- 2o14)

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Untitled Map
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Legend
903 Arrowhead Trail
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