Canady, Jeremy 77051C

CAMA / ❑ DREDGE & FILL lid 77051 A B /(C ,D
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ENERAL PERMIT Previous permit# �..._/New ❑Modification ❑Complete Reissue ❑Partial Reissue Date pr vious permit i d
ed by the State of North Carolina, Department of Environmental Quality ,
and the Coastal Resources Commission in an area of environnVntal concern pursuant to 15A NCAC
Rules (ached.
Applicant Name 0 Project Location: County rA
Address _ Stre-et Addressi-tate Road/ Lot #(s)
City tate ZIP6�h
Phone # -Mail
Authorized Agent
CW W YTA ❑ES ❑PTS
Affected oEA ❑ HHF ❑ UBA ❑ N/A
AEC(s):
❑ PW
ORW: yes /I D PNA yes /�
Type of Projkct/ Activity
Pier (dock)"length
Fixed Platform(s) Imo•
Floating Platform(s)
Finger pier(s)
Groin length
number's
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards "s
Boat ramp -
Boathouse/ Boatlift
Beach Bulldozing, - /,--
Other irryl lg _I_�;
Shoreline Length
SAV: not sure yes o--..-....-
Moratorium: n/a yes o
Photos: yes o
....
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction`
Alnf-eel r narinl VTvr%Aitinn5 I
Appl
V d
(Scale: 1)
❑ Snote on bl3clfegarding River Basin r�ufles. g]�l
!,mature Please read compliance statem nt on back of permit
application Fee(s) Check #
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, certifythat this 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 complywith 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ':S' f -eM `I
Mailing Address:G) IZcLz-
Phone Number:
Email Address: \ '
I certify that I have authorized' ll��
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: '�-ber--
at my property located a33
t) t c��S� G�,L C—'
in 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:
//��Z
Signature
Print or Type Name
Title
I )"a— / aD
Date
This certification is valid through 1 l

s
y
;,. .�,..
r

ADJACENT RIPARIAN PRQpERT`( OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at d dress,Lot, RRRa_d, etc
on in �
( W;a _�� ,N.C.
�, _
(Waterbody)(CitylTown end/or County)
The applicant as described to me, as shown below, the development proposed at the above
location.
I have no objection to th!s 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)
DP- P,wl0 G
ONa, t
`per
IN
t 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 vaive-d 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 i 5' setback requirement
(Propeerty Owner Inform
R e� YD14
23
Ma'r!�- Ig Add rs
CitylStat ip
Telephone Number
Date
(Adjacent Property Owner Information)
Printor pe �Name
Ma/'h'ng Address
7,4q)ho,1?.1�-- — -
(Revised 6/1n012)

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9

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f f�'l Glhl3k �� —'s
D. (Name of Property Owner)
property located at �� t �99 __) GIB -
(Address, Lot, Block, R,Qad, etc.) I_ oni'- in 3 Giro dun
N. C.
(Waterbody) (city/Town nd/or Coty)
The applicant as described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
4kIff)6� cD D7P'Pt L )0 6
7juiL-D 14 t5*)STlt_1G
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Inform
Print or TyRq Name
Mai_ ling A�ddw�ss�� u ,�
city/ip
Telephone Number
—A-
Date
(Adjacent Property Owner Information)
Sigr_ltute r
Ipntor
J'S ype Name
1
Mailing Address
.Date
on Number
(Revised 6118/2012)

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