Holste, Douglas 79592C

AMA / D DREDGE & FILL N9 79592.
GENERAL PERMIT Previous permit # A B D
New ❑Modification ('Complete Reissue E.Partial Reissue Date previous permit issued
Asa horized by the State of North Carolina, Department of Environmental Quality -7 % i / r7,, ,
and the Coastal Resources
is mmissio in an area f v on ental concern pursuant to ISA NCAC I t s Led.
t / 0 t4 1 �s / 1, /� q es attached.
Applicant Name_ _tn✓ V�A/ ��' CCC... _ Project Location: County_.. C: c°✓ ^_ __ __
Address_ Street Address/ State Road/ Lot # _
City_ _lf �e^y rK/ _-- States._ ZIP � »il of
Phone # (�l_ -�G(�) E_Mail
Authorized Agent __'0 Z
Affected --`CW 2mr , �-r'PrA 7,Ees orrs
AEC(s): :IOEA CHHK GIH DUSA QN/A
ORW: (yesj/ no PNA
Subdivision]
City—. /Y- ZIP I
Phone # () Rixer Basin-�_�^
Adj. Wtr. Body Q ✓ ✓ in nkn)
Closest Maj.
Wtr.Body
__...
Type of Project/ Activity .� ! de
�) T
Pier (dock) length_ (Scale. )
Fixed Platform . 77_� v
Floating Plad V - ' --
>f*.
Finger pier(s).
Groin length_
number .,
I I
Bulkhead/ Riprap length .... _ i ..... - . _ :.. _..
avg distance offshore_
max distance offshore
Basin. channel
cubic yards
BosttarnP
-._ .._ .. -
Boathous -0-91
Beach Bulldozing__
other__ :.._, __.__._. _,- _._ _r
'or
Shoreline-
SAV: not sure yos no
Moratorium: Na yes
Waiver Attached: es __ - __.��Pj�•.. '� _ __. __.,.... .._...�
A building permit may be required by: C! " ter C � i' See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditionp
X gentoy����u�V. _ --- -
AgentApplicant Printed NamO Pertfice niclNr's Ptfttylg me
9gnatvr • ease ad comp' as �e enton back of r t1k Signature -� - -
--
Appl' Feels) Check# issuing a Ex it ion to

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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑Tar -Pamlico River Basin Buffer Rules ❑
❑ 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:
Mailing Address:
Phone Number: C 1
0I -1
Email Address: J
I certify that I have authorized C bcC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: i-\ PM WN M V ,
at my property located at
in County.
1 furthermore certify that I 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 Information:
Signature
Pn&4 Type Name
Title
Date
This certification is valid through /

U -I—
� a
Q
CP j
CERTIFIED MAIL . RETURN RECEIPT REQUESTED
DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. b
Address of Property:
(Lot or Street #, Street or Road,
Agent's Name#. Mailing Address:
Agent's phone#,
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawkw, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal. y
If you have objections towhatisbeingproposed,youmustnotifytheDivisionofCoastalManagement II2
(DCMj In writing within 10 days of receipt of this notice. Contact information for DCM offices is V
availableathtbnfiw w.nccoastalmanagemenLnethveWciWateffdistlnoarbycalling t-U8-4RCOAST. rt
No response Is considered the some as no objection if you have been notified by Certified Mail. %C
o -
WAIVER SECTION C
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must \g
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.
(PT
pey O ner Info ati n)
Signatur
jA'j scat L U`�
Print or Typo Name
Mailing Address
ClfylStete/zip
C�tiUilGm ��to� ��iax•��s;�,:�;
Telephone Number/Email Addre t� •Ctk t
Date
(Riparian Property Owner Information)
S* e/1 v7
Print or Type Name
4'J� fH756<r;,.,c b*--
Malling Address
4+ r 4W, 41e, y
awNeteop
Telephone Number/Emarl Address
0-71 ?1/';?4
Date
(Revised Aug. 2014)

.fRpEr LMAIL - RETURN RECEIPT RIO L _ -- _q!aILE0
C,-.VISICN OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICAVONWAIVER FORM
t.
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WAIVEASECTION
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