Grove, Charles J. 79696C

i AMA 1 "DREDGE ds FILL M 79696 A B OC
ENERAL PERMIT / Previous permit#
ew Modfitat on Complete ReizSGePartiat Reissue Date prey' us permit issued
As autho zed by the Swte of Notth Carolina, Department of Environmental Quality
and the Coastal Res rc s Can "ssion in an area of environ ntal cottcem ursuant to I SA NCAC�
,.,,,,,,../� R os Alta td.
Applicant Name (. P jett Location: County,
Add i y _._. Street AddreW Cate Road/ Lot #((s)�M,
Gry State_7lP_/ 1� �l !
Phone � ..�_ �?�. Mail w.. �~ __...._�.. � Subdivi an
Authorized Agent}_ City ZIP _ _
Affected -1 eW EW , TA ❑ ES a PTS Phone # W _ er Basinl
AEC s : oeA HH C USA GN(A Ad'. Wtr. Bnd r l� w_
�) - pW5t I y ( .. not /man, Jggkp)
ORW: yes J PNA yes / Closest Mal. Wtr. Body- L
Type of Project/ Activity
(scale,
Pier (dock) length
Fixed Plattonn(s) (1S`�t.j�'�„V
Floating Pudorm(s)
C.rcin length
number
eulkhead/Popraplength
avg distance offshore— {y�
it= distance offshore
exam, channel` —`
cubic �,ds
✓ ,V�{ _
Boat ramp
Boathouse/ o if
Beach Bulnfoz ng Other -
Shoreline Langth
SAV, rot sure Yes
Moratorium Na yesMeter. Yes
l
_ JJJ
Waiver A[SaS hed:
A building permit may be required
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
See tote on back resiArdmti River Basin rules.
°` Crca I compliance statementpnisackofti rmittSign{ `
Fco(s) Check %t rcaHon Datt

®CAMA / ❑DREDGE & FILL N9 79696 A B OC
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date pr v' us permit issued
As autho zed by the State of North Carolina, Department of Environmental Quality
and the Coastal Res rcs Com fission in an area of envirompental concern ursuant to 15A NCAC
es atta ed.
Applicant Name Project Location: County
Addres Street Address/ State Road/ Lot #(s)
City 1Vt
State IP / I n V/
Phone #IMail �� Subdivision
Authorized ACity � ZIP nn
Affected �TA ❑ES ❑PTS Phone # er BasinAEC(s): 1-1H ❑ uBA ❑ WA Adj. Wtr. Body nat man unkn
❑ PWS:
ORW: yes / no PPNA yes / (97") Closest Maj. Wtr. Body
Type of Project/ Activity I`
J'�=1
' (Scale: )
Pier (dock)length—
/ _
Fixed Platform(s)
Floating Platform(s) I j—~ t `_
i T I i i
Finger pier(s)Groin length
number --
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channeT—
cubic yards �-� 1`' ` I — �f �•T'I
tiU1 j
Boat ramp _
Boathouse/ o li( ' -
!
Beach Bulldozing -
f
Other
C �ar C O
Shoreline Length Wo _ �C `Al � \�.
SAV: not sure yes o
Moratorium: n/a yes
Photos:
Waiver Attached:
A building permit may be required by: ! ❑ See note on back regardin River Basin rules.
( Note Local Planning Jurisdiction) L� /, 4
Notes/ Special Conditions J w t
nnn���ttppp�— � V / ✓ V-f� V
re fie read e compliance statemnt back of @rmit' Sign ' �
'Application Fee(s) P Chedk# Issu;,?a/, �x iration 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
Iandowner(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)
R,
http://portal.ncdimcorg/web/cnVdcm-home
Revised 7/06/17

AGENT AUTHO_• RIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
122 A j
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r he
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at m//y property located at _
in County.
i furthermore certify that 1 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 no Information:
�((Signature
�rdt C
Print or type Name
Title
0Z l C>P/ 2v� I
Date
This certification is valid through /_ZIP / 44 '2 7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ J GtYt mr�pV-
Property located at ( 3 PpnA 41rr
(Name of Property Owner) s
on ------ wL, 010GN, tt0a0�etC.) q
(Waterbody) 'in LG4I ^'C' niacC%l N.C.
(Clty/Town and/or County)
The applicant has described to me, as shown below, the development Proposed at the above
loc 'o
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)
I(ZI
3D'
%(
t I
�Ij�IZ G"5 9 WAI ER 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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
u'Srrmgur-e— - (/�'
y a; 1) A
Pnnt or Type Name
'Valid for one calendar year after signature* (Revised Aug. 2014)

ADJ CENT RIPARIAN PROPERTY OWNER TATEMENT
I hereby certify that I own property adjacent to s ) ( ,
(Name of Property Owner) s
Property located at �ea nd �.
fxoaa,
in ��`c i&e � ,N.C.
(Waterbody) (Cityn own and/or County)
The applica
locafiont 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 nil In description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be setbacka minimum distance of 15' from my area of riparian access unless waived by
me. (If you ish 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.
Information)
Pnnt or Tvne Name
*Valid for one calendar year after signature" (Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
is
Property located at 3=� PD n A (Name of Property Owner)
on (Address, L t, Block, Road, etc.)
(Waterbody) rn� ti, �e� (City/Town and/or County) N.C.
The applicant has described to me, as shown below, the development proposed at the above
localior�
✓✓ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividuai proposing development must fill in description below or attach 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 ou ish to waive the setback, you must Initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
(P
I do not wish to waive the 15' setback requirement.
Information)
�rj�r(ce{e FG^�
Pnnt or Type Name
2Zyt--- � L^=-r` I a
Marlurg Address
City/StatefZlp —'
—Y uz cf
Telephone Number/entail address
Drrte
h.2 �n a- '7 i
°Valid for one calendar year after signature`
(Adjac� nt Property Owner nformation)
DrrrN*
V' •rrCi—rk'
(Revised Aug. 2014)