Jones, Raymond 80444C

AMA / El DREDGE & FILL
ENERAL PERMIT
New fby th❑Modification ❑Complete Reissue
As auth ri ed e State of North Carolina, Department of
and the Coastal Resogfchs Commission in an area 54 Qnv^nn
Applicant Name
u
ZIP
Phone
Authorized Agent
Affected ❑ CW W PTA ❑ ES �CA7
AEC(s): ❑ OEA HF I UBA ❑
PWS:
ORW: yes / no PNA yes /
Type of Project/ Activity ' Y-fib ;�� 4.
9 80444 A B C D
�
Previous permit #
❑Partial Reissue Date reviou permit issued
conmental Quality /
al concern pursuant to 15A NCAC
e attac ed.
/1roject Location: County
Street Address/ State Road/ Lot #(s)
Subd i i n
Closest Maj. Wtr. Body
(Scale: / J ) )
Pier (dock) length
Fixed Platform(s) -
Floating Platform(s)
Finger pier(s) i
i
i'
Groin length
number -
fi
Bulkhead/ Riprap length
avg distance offshore i
max distance offshore
Basin, channel —
cubic yards -r j'' `i UY
Boat ramp �--
Boathouse/ Boatlift--_
Beach
Other
A building permit may be required by: ❑(nSee note on back re ardin River Basin
( Note Local Planning Jurisdiction) Q P A A A A r 1 "E`i /a I/ r a n� �\ n S i I
4
Printed Mrie -'- W / Permit
JSignature � n Rease read compliance statement on back of permit Signature r
od �1C /�� - 971 �)-1
pp a ion Fee(s) Check# s ing D e xpirati 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 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 ❑ 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/ I-888-4RCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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: R,2.VA 0 j_G� �/�,J ®N
Mailing Address: S`� Ald )'"
Phone Number: 9 2�.? P
Email Address: © 012- 601-6 0 co AA
I certify that I have authorized��
AgdrA / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: .P &,iq Q_
/d a of
at my property located at 74 IJ P. 00. .`i<'
in CoP is ile. '*' County.
l furthermore certify that l am authorized to grant, and do in fact grant permissio+
Division of Coastal Management staff, the Local Permit Officer and their agents to e
on the aforementioned lands in connection with evaluating information related to
;Permit application.
Property Owner Information:
t
17
Signature
?a-V.4A0.y0C If,'d 10 eS
Print or Type Name
A] CI' -
Title
Data
This certification is valid through —Q lV

AWMENT RIPARIAN PROPIRTY OWNER STAT9MENT
I hereby certify that I own property adjacent to _A07 ,f0,t/ / f 1// `J �Ne s >s
fI (Name of Property Owner)
property located at N e �b r
on,� ( ddress, Lot, Block, Road, etc.)
�"��� �� r• C��� , in -- C-a,n e C o C`-f'e e , N.C.
(Waterbody) Ci(�ity/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
ma-vt
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must till in description below or attach a site drawing)
y i •�
t �� y
z <(A(WL yJ;
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.)
{ 1 ` I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
1
S' store
b N �¢rt CS
tint of Type Name
Mailing Addres Y
C--" e Cry r^-Wr,et AJC o2 �!-kr
Cit /State/Zip
.25a_ -,,I; 9- 97-3.97
Telephone Number/email address
Date
1-nnt or Type Name
M$ilin A re .�
City/state2ip
Telephone um ,per/ email address
G .Z 1
Date
(.Revisod Aug. 404,Y;

! hereby certify that I own property adjacent to 14' T s
(Name f Property Owner)
property located at 6" 0,
( ddress, Lot, dock, Road, etc.)
on _�' 1_q % ra� i ��. , in ac o e_ C_Q A fn k' , N.C.
(VNaterbody) (City/Towand/or County)
The applicant has described to me, as shown below, the development proposed at the above
Ocatio
a 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 she drawing)
e'A(ti S
WAIVER SECTION
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.)
%JJ
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Telephone Nu ber/email address
Uat
Mi , ing Address
City/State2ip
Z `Z .' ZS1��
Telephone Number/ email address
4--zi ,f
Date*
(,Revised A.-g. 4.V I- /