Cox, Jan 78813C

1119121, 7:48 PM
J�( tA- DREDGE i FILL
\ 0 -!� ti I; A B� D
GENERAL 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
Coastal Resources Commission
// C
and the In an area of environmental concern pursuant
to I SA NCACC2
`'� %�
Applicant Name ✓t� CCn l.A�( ._
Project Location:
Rule anachad.
County Qa9.6/riv---
I'
Address 9,�Q �^-+"+•`A —} i Q) I ADijt� Land
City SIIC1p43A✓fiPy -- State 'VG ZIP
Street Address✓ State Road/ Lot #(s)
-- -- — — — --
Phone # 11 ) X- /0t E-Mail _
Subdivision
-- _
A1 LL n
Authorized Agent I � I V I Ck , A I nsc I
City
ZIP
__
Affected I CW * d "A -\IS . IP1S
_ ,__ _ _
Phone # (.
) River Basin���ly
AEC(s): J OEA ; ! HHF L' IH I_ UBA J WA
Adj. Wtr,Body.
I� � ��,k &/man junkn)
_1 Pws.
ORW: yes l no PNA / ee%/ no
Closest Mal. Wtr. Body CJ
Type of Project/ Activity
Pier (clock) length
Fixed Pli forms)
Floating Platform(s) _
Fenger per(s)
Groin length
--
number i y
Bulkhe Nprap length I
I l
avg dnarne offshore
max distance offshore._��
Basin, channel +_
;
cubic yards ..i --_
Boathouse/ lloaWt__
Beath Bulldozing
Other/ .. ... .---- I -_ .... . . .. .....
shoreline t.ength
SW; not sum yes o j
Moratorium: We yes
Photo: yes no
Waher Attached: yes n :.__ -.._ ___.._ _..-
A building permit may be required by: / n 101 l) ro f {(j�
( Note Loral Special
Condition jurisdiction) N� tin
Notes/ Special Conditions A (/
GR
6 Ctt nn ea ame
Sig leewereadwmpll�tatementonbackofppe itee
JFiicaumfeaU) Check As
a„2 y
(Scale:/s)
---_ .I�.._....--
Cx
U Sea note on back regarding River Basin rules.
--- - Cccl nn(2 I/
PerrrYtOlOc s Printed Nyne_
slgnatu
I td e r E Ir d o Dat-e --.

WNew AMA / DREDGE & FILL � � V N9 78813 A B � D
ENERAL PERMIT Previous permit#
❑Modification [-]Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 7
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC_V 'i-I • �/
Rules attached.
Applicant Name Project Location: County_04 S/'2fV
Address 0-Y167 Street Address/ State Road/ Lot #(s) mow/ u /
City State MC ZIPB
Phone # V-) E-Mail Subdivision
Authorized Agent V I G I City ZIP
Affected LJ CW _LVM tPiA J�KS ❑ PTS Phone # (_) L-Jr
\ /River Basin
AEC(s): Ll OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body IX,id l ,may gnat �/_ _man /unkn)
❑ PWS: CANORW: yes / no PNA �/ no Closest Maj. Wtr. ^ !�
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number i
Bulkhe /Ripraplength_L'
avg distance offshore_
max distance offshore_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length / .✓V
SAV: not sure yes o
Moratorium: n/a yes no
Photos: yes no �'..—
Waiver Attached: yes n
A building permit may be required by:
( Note Local Planning jurisdiction
Notes/ Special Conditions
or Applicant Printed Name
/i 1"7"� /
(Scale:/ �'4U )
❑ See note on back regarding River Basin rules.
t I n/ I
Sig Lure ** Please read compliance statementon backof permit**
Application Fee(s) Check #
Signature
Issu' g D to E irati n 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 andvoid.
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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/1-888ARCOAST
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

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Carol �a n 0, C x
Address of Property: 1,ei 7 (.taar
(Lot o/r]Street #, Sttre
Agent's Name#: G11 tit �Z Alt t)K
Agent's phone #: O' `l� ' SSoo
or Road, City & County) 1'
Mailing Address: 7- �1 4
a&C ,-OIVIJI��r',
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 drawing with dimensions must be provided with this letter.
r k— I have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405.3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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
I do wish to waive the 15' setback requirement. rip1 S�^I
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
(I-. C:)� G
Signature
a. Jan
Print or Type Name
/,Vl ee0br follow Ln
Mailing Address
,5ncads ay:�z
City/StatelZip
G . 9lt7lVo-1044
Telephone Number
Date
(Adcen Pro Owner Information)
ign ure
Print or Type Name
/l / ` I
MailingJairess
City/State/Zip
Telephone Number
--�=/Z ZO _ RECEIVED
Date
Revised6118128E 072OZO
DCM-MHD CITY

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
I I DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: �(��7r j G16 W 4/1
(Lot 'r Streelt�#, Street or Road, City & County) ' I pp ttrr /�1
Agent's Name #: f �y MailingAddress: Z1 q O `� V is �� MQCI t
Agent's phone #:Ck1�- �`�5� �QC � YI �1� N,C- "864v
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 drawing with dimensions must be provided with this letter.
't �\.1 I have no objections to this proposal. I have objections to this proposal.
If you have objections to what Is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive FA,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection If you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.) (aj C eG woa1 I
z I do wish to waive the 15' setback requirement. C- fUA - D ( e-Y-�l Stt"
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signa r
e J2Pq coy
Print or Type Name
I
Mailing Address
�a�-5 eNr\l AIA
tty/State/Zip
gr9/9W-/01/Y
Telephone Number
/ho o
Date �V_
(Adjacent Pr9ferty Owner Information)
--
Signature
�/oklm
Print or Type Name
qi PODIA !g,
Mailing Address
IPm �N 0301�
City/State/Zip
(dn -z. 55-� ` qI l
Telephone Number
lo-25-ZD20
Date
Revised 611812012

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5

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �a r6l —JQ h C G� v
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and
�(C
obtaining all CAMA permits
necessary for the following proposed development: J ` (') `SQ a, WGL`
at my property located at I?--t G2 80j oI1bW Lm
in © des 1 DO) County.
I 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
Print or Type Name
Title
This certification is valid through b 1 ZD 12-1

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11 /1 1 7:48 P
�CAFWA 4A.- DREDGE A FILL
GENERAL PERMIT
�'New Modification Complete Reissue ._Partial Reissue
As authon'ied by the State
of North Carolina,
Department of Environrrxntal
Quality
and the
coastal
Resources
Commission in an
srca of environmental
concern
oursuanc to 15A N[AC
ApplicantName �Z(�6D)(
Address -�.X-! caftH—�_QIIL��,� --
Land
City Sn�s Y state ZIP�2��
Phone # . E-Mail
Authorized agent , _
Affected
AEC(s):
OR
W*
1-1 Cw
0 OEA
4_! HHF
Ak"A PTS
L' I L UBA U WA
:7 PWS:
yes /(no) PNA e�1 no
A B OD
C D
Previous permit #
Date previous permit issued
�%7 f 1 I lI `1
�jRula attsthed.
Project Location; County C)'1'G1'rLV
Street Address) State Road) Lot #(s) _ _ _ 5�AA14 �
Subdivision--
Phone#
Adm. Wtr, ILMIC A
I Y_ LIEW It
Closest Maj. Wtr. Body-
-�
/rqan /unkn
" fdljCl�
Type or Project/ Activity
4' � rt C �
(Scale:
Pier (datk)lenotl, •--� - - -- -
r Or
Fixed Platform(s)
Floating Plarform(s) 4
FInr pled s
Grain length _
I LA i
}
Sul
ul F-
13C
FUprap length F y I
F
a + + r f ■ + 1
a dIsw offshore �. ''•� i y 1 +
k
m distance �s�
s� i ��� � aw�t �� �w - •- -0 �- •� ` - - } - - 4. - � .. lipw - _ - r �� �++t • ��.��r i� t r.�F ti+--ti�� -
nne # ` #
1�V
i
I P (X
MEN
,
ramp
Boat
���a � • - � —f + � � • t � � � t �J �� -r ��—may'
housO Swd lift
I ] F L I � IN
Beach Bulldozing -- f ! r_; 4 IIL 40-
t I Ti
Other
� ' I k i
Lopp
feline . _.. a .. - - I -- - -
i 1 ,
1 i r I
9
SAV: not s u - �.- y 1 { , ` _ r
q I i 1
no
_ # 1 t ti
F � Rio I 1 a1d. _ 1 a
7 1 7 F L
1a� Attached; ��- - - - -. - 1 �. ... _ ____ `
,MOW.
�s ��
A building permit may be required by:
(Note Laval Planning jurisdiction)
Notes/ Special Conditions
U See rote 4n back regarding River basin rules,
Y � `
OL 171
or licant
nted Name Permit Oific s Printed
Sig cure " PIease read compliance statement on bask of perm it
0
APplicauon Fee(s) Check #
S
lgndii-e-
OL
Is
E
ai r Date