King, Robin 79680C

0r.CAMA / ❑DREDGE &FILL £} 79680 A i3
ENERAL PERMIT Previous permit#
New ❑Modification [-]Complete Reissue El Partial Reissue Date previous ermit issued
As authorized by the State of North Carolina, Department of Environmental Quality D
and the Coastal Resour es Commission in an area of environmental concern pursuant to 15A NCAC
` \n Rules atta ed.
Applicant Name r 1 �� Project Location: County
/—
Address Street Add r / State Road/ Lot #(s)
Beach Bu
Otherd
or scant Panted Name `� Permit
pp
Signatur **Plepsie a compliance statement on back of permit" Signat
A station Feels) Cb�l�# Issuing ate Expir tion 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, 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 howto 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/ 1-888ARCOAST 252-946-6481
Fax: [phone] 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)
(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
0
Name of Property Owner Requesting Permit:
4/9
Mailing Address:
Phone Number: �� " 7 3,0 - Y� o
Email Address: 'D4AM'eAT�-�
I certify that I have authorized ()I U e- Imo' t '4'5
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �� `� Ek ��"_ 1 �a
at my property located at 6-0-3/ wi-136 (r /700/1 iA-6
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:
�<.e-? f?�
Signature
Rol
Print or Type Name
06414Ae
Title
.) I '� I )--
Date
This certification is valid through I I
I
Ck
RECEIVED
APR 19 2021
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
%O!� � "J�
I hereby certify that I own property adjacent to /iU '� s
(Name of Property Owner)
property located at � �� � `� C �
(Address, Lot, Bloc ,
on 5Odn/f�'S ���1 %C , in /�D�f HM " , N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
-\v I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(inaGvidual proposing development must fill in description below or attach a site drawing)
J
i
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 16 setback requirement.
(Property Owner information)
Pont or Type Name
ell —
Mailing Adqress
CT/4�,'6
lZi�3 U �f 5
Telephone Number
Date
(Adlacent Property Owner Information)
t
Date APR 19 2021
(Revised 611 W01
CITY

R

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /L�
(Name of Property Owner)
property located at � �� � � �� � T
(Address, Lot, Block, d, tc.)
on `Pl�Pj�Jc�IPS ('%'��/t in /�III,Cf'n1,__ . N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Ine9vidual proposing development must fill In description below or attach a site drawing)
0 0
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.)
r, 24 I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
(Property Owner information) 1 (6 't
(Ad acen) Property Owner Information)
--
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Stmature Si tore
Pnnt or Type Name Pri t T tme
Mailing Ad ress Wilin dd ss ,
Crtt�{s�tte/Z"/ 3 0fir U City/ tat
'relephone Number Telephone Number RECEIVED
Date
Date
APR 19 2021
(Revised 6118r2012)
DCM-MHD CITY

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