Emerson, Dave 80060C

®IX CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
IffNew 011odification []Complete Reissue ❑Partial Reissue
N9 80060
Previous permit #_
Date previous permit
A B (C D
As authorized by the State of North Carolina, Department of Environmental Quality ' / �1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC C3,�y ��c �Jl
Rules attached.
Applicant Name U rAW C I mpp __'Or)
Address C
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E-Mail
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Affected ❑CW ❑EW kPTA ❑ES 4IfTS
❑OEA ❑HHF ❑IH ❑UBA El N/A
AEC(s):
❑ PWS:
ORW: yes / no PNA yes '/ no
Project Location: County C-2 V F,a
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(Age t or1licant Printed\ Name (�
Signature '* Please read compliance statement onbac ofpermit
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Application Fee(s) Check #
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PermitOfficer's Printed Name l
Signa ure
In ing Da a 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
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
❑ Neuse River Basin Buffer Rules
❑ Other:
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 howto 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 fiver 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 Pander Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

NCAMA / ❑ DREDGE & FILL N. O
80060 A B A D
GENERAL PERMIT Previous permit#
XNeW ❑Modification ❑Complete Reissue ❑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 15A NCAC ' 7 //1
f7Rules attached.
Applicant Name !-lV( % r,,if N far?
Address
City Statet�ZIPr1i?-/,
Phone #(/�')�l`�'��(�� E-Mail
Authorized Agent P v\ '+' 1 ' 1,; r, i J I -
Affected ❑OW SEW PTA ❑ES .CI}PTS
A
Affecte ❑ OEA ElHHF ElIH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Project Location: County
Street Address/ State Road/ Lot #(s) 0 t i /(
Subdivision
i
City X/ ZIP
Phone# O River Basin
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Agent orjA7licant Printed Name
Permit Officers Printed Name /
Signature **Please read compliance statement on backof permit**
Check#
Application Fee(s)
Signature
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 officerwhen 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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑Tar -Pamlico River Basin Buffer Rules El 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/ I-888-4RCOAST
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

Mailing Address: :506 W. /wir5on CverK ,vr.
/ ecti 1 Llio owls nJ c, 2 �56 Z
Phone Number: S'/ 3- S/ % 8/ 8 /
Email Address: hp°r cme, sj•+) /9-vg- if C'~F-/' `."
I certify that I have authorized Rom if tr
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtainingg all CAMA permits
necessary for the following proposed development: qi U lock ��Ug� /.00k
at my property located at 3 9),6 0- wJ-10" C e-ee K 0"
in erad�"k County.
/ 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
w.rc G'i%�e✓sue 1
Print or Type Name
0`gNP/
Title
7 l /3 I 2l
Date
This certification is valid through

I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: back Em e.+yp,✓
Address of Property: 306 W, lajsc, Cr{�j< br Ti.wf tJooa) nl c
Mailing Address of Owner: Sa,K.- ^ -, - 6.vt_
Owner's email &4d EMer'507 P755 060 °,Ownner'er'
s Phone#:
Agent's Name: Rives 4ti1- Mn nac ('„�51, Agent Ph
Agent's Email
3 - 5-/ 9. 8/P/
91q-92v -g213
2 pS6 Z
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
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
I DO NOT have objections to this proposal. I DO have objections to this proposal.
rr you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 CommerceAve., Morehead City, NC 28557. 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 any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Owner: ; (-m ql &
Typed/Printed name of ARPO:
Mailing Address of ARPO:��
ARPO's en il: G (Zf yi gCtcfCe&Crr'ARPO's hone#: j -2 C-3rn f h3
Date: f6 202 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

tr 15/2021
Yet ft
PropertyOwnerPom ipg
i{ t
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVER`(
("rop portion to be completed by owner or their agent)
Name of Property Owner: _ belye_
Address of Property: __ 3 6 W, �'�Sov, �✓ t �l< I%� %ic�+� GJoorjS N c . :� a'Sb 2
Mailing Address of Owner: _ ✓.gr N/ ey3 n F�
Owner's email Dnw�tMe�� Igss' �G+"la, OWwonw er's Phoned: � ✓ �'
Agent's Name: Riya✓ 41 f 4% 'LC Agent Phoned: 91i' 9 Z-D - 9 Z f3
.Agent's Email•.
2sz- y/y- 43z'1
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
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.
---)L I DO NOT have objections to this proposal. I DO have objections to this proposal.
If You have objections to what is being proposed, you must notify the N.C. Division or coasrar
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
.mailed to 400 Commerce Ave., Morehead City, NC 28557. 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 any proposed 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
(this does not apply to bulkheads or riprap revetments). (/�-y7ou wish a the s backl,you jm�ust st
the appropriate blank below.), / / /\ / g
I DO wish to waive some/all of the 15' setback
Signature of(/ldjdceM-RipNr-tan Property Owner
-OR-
I do not wish to waive the 15' setback requirement (in"I the blaq)t)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: )UI l f7V rt/C-
Mailing Address o/f /A_R/IPO: ��J��©� //C
ARPO's email:,0�CJ�1�f/�' eARPO's Phoned: ZS z J �
Date: % waiver is valid for up to one year from ARPO's Signature'
Revised May 2021
https://mail google.com/mait/u/0/?lab=nn&ogbil/search/daveemerson1955%40gmail.com?pmjector--I

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