Willis, Chandler 78296C

MA / ❑ DREDGE & FILL NO 78296 A B C
NERAL PERMIT Previous permit#
❑Modification ❑Complete Reissue El Partial Reissue Date prexious permit issued
Signat"Tre ** Please read compliance statement on back
�o.-f�permit
Application Fee(s) Check #
Iss

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, 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C ki a ►n _/' C-j 11! t s —
Mailing Address:li�/Ijo/76
man �,4el.. lie o�s/o2
Phone Number:
crnail .addr_ss: ��Y/ll/l(✓ GI/� %l5 2`y- GOm
I certify that I have authorized m d '[Drm<$-, t ►�� ?!-<< _
Agent Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAIVIA permits
necessary for 'he following proposed development: Seff 4 Lt c t ?I) NSS
e
e-t 1 i
I n S f ►-? o
Lit ow property located ato
�Gt/IT/G
C�G��I &����1'.
r7' "
! n i'-'A 2,7� ou n z .
i furthermore certify that I am authorized to grant, and do in fact grant 'permission to
Dwision o; Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforen-er7troned lanes in connection with evaluating information related to this
permit application
Property Owner Information: �-0
Signature k
fit/ ,
Pr;m -)r 1,,pe Ni fne
RECEIVED
T � tie
l l dal FEB 2 4 2021
7?3If'.
DCM-MHD CITY
Timis certifi:,at;or. I5 :ai.�i'flruu��h

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4

ADJACENT RIPARiA PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C .L riw' j
( e of Pr?prty wn r)
property located at �Z 6 ) �� ►� `'' I G j �G C (Address, L-pt, Block, Road, e � W 6 N C.
(7
on w �1 in F+ -F �- A h 4- i /,-----
(Waterbody) (Citylfown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio7.
� I have no objection to this proposal
/_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)
N
jlipl
WAIVER SECTION --
I understand /hat 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 appropnote blank below)
do wish to waive the 1 5' sotback requirement
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
JILA- -
C_1St 1L
lonnt or Typo !Name �(
a%1,57AVan h.
Mahn Address JVG 5/2
CA , t�
;etr:�hnr :Nignber
(Adjacent Property Cr#oer Information)
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