Tucker, David 78287C

CAMA / ❑ DREDGE & FILL N9 78287 A B (D D
ENERAL PERMIT Previous permit #
ew ❑Modification ❑Complete Reiss:ae El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission 'an area of envi onmental tern pursuant to I SA NCAC )1/0
� - Rules a ched.
Applicant Name Project Location: County_
AddressT_ Street Address/ State Road/ Lot #(s)
City State ZIPS
Phone 4a) E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑nnORW: yes /PNA yes / n(o A
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) �r
Floating Platform(s)
Finger pier(s)
Groin length's
�lumbei�'� t
Bulkhead/ Riprap length)-0-71
avg distance offshore
max distance` offshore ni fL
Basin, channel
cubic yards------�
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
L
Shoreline Length 01�,\ 1
SAV: not sure yes o ()
�1V...,
Moratorium: n/a yes o
Photos: yes no
Waiver Attached: yes o
A building permit may be required by: V
( Note Local Planning Jurisdiction"6),,
Notes/ Sppcial Condi{jons
Applicant Printed N
Subdivision
City_
Phone #
Adj. Wtr. E
Closest Maj. Wtr. Body
❑ See
Permit
ZIPS
l� (nat
(Scale: / / ` )
on back regardine River Basin
Signature ease read compliance statement bat of,permit l*
Application Fee(s)
C ec4
Nnaate piration ate

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 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 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:
Mailing Address:
Phone Number: 2 5 Z '�H Z LI g$
Email Address:
I certify that I have authorized gh/t wo-jl-y�
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: "Je `✓ ►� /kLitoJ
at my property located at �%2 %�Tt'ar�I'C' 6e o�
in (cr� -ey-kf County.
I furthermore certify that .1 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
Print or Type Name
Title
A_I Zo 2
Date
This certification is valid through I2 1 3 0 1 20 Z 1
remprronuw r ema address elephone Number / email address
1- A/- 71

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ADJACENT RIPARIAN PROPERTY OWNER STATGA^1•--
I herebv r--
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (Name of Property Owner)
property located at Z (��1�P4� �uS�W
(Address, Lot, BIQP , R d, etc.) / N.C.
on Care in Yrl,
(Waterbody) (City/Town and/or County)
The a plicant has described to me, as shown below, the development proposed at the above
locat� n.
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 site drawing)
9-P' P (wLf— F/c r5
o J lo��J
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
m you wi h 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.
( �e�y'wner Information)
Sign tune n
Print o�Type Na e
2Yo /Y�, ed
Mailing gadd ss ,, s
tr r ' 16
City/State/Zip
2'z— 3Y2—y88�
Telephone Number/email address
/— iq-- 71
(Adjacent
Prht Type �ap�e
M 65,E
- I g Addr&s -
C It State/Zip r
Telephone Number / email address
n)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to U 11,c S A r
/ (Name of Property Owner) s
property located at // Z� �oi cal (,-k. ,e-w
(Address, Lot, Bloc , Road, etc.)
on ��►.� �tihL /5"-
(Waterbod �n N,C.
y) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to a
Ltl - 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 site drawing)
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 yV 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 requ
(Property Owner Information)
A44114"
Signature
Print or Type Name
Zyan 13,^,Ijer V� -
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City/State/Zip
252--34-2-L/
Telephone Number/ email address
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Date
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14G`°�,1�
citylst�ip�///
Teleph e N mber/email address
bail*
(Revised Aug. 2014)
"Valid for one calendar year after signature'

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RECEIVED
JAN 06 20 11
DCM-MHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
/vp— 5�. r X-� 's
I hereby certify that I own property adjacent to _ Namp of Property Owner)
property located at
on !'-"in4�k
(Waterbody)
(Address, Lot, BI�R, ) ti N.C.
in
(CityRown andlor County)
The applicant has 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 fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance o m' from my area of riparian access unle
ust initial the appropriate blank below.) s waived by
me. (if you wish to waive the setba , y
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Propb)ty Owner Information)
(Property Owner Information) ..----
Signatu ;Gi`.,G
S' ature
6, Print or Type a e
r
Print or Type Name i c
yn
�y., .l e� St?/K17/
Zyvo Ma�Jri,gg ddress
Mailing ddress , (, 5-7 A.11 v �C'
�`-"`� C,�/ , nr�- Z 5 City/Sta`t�/Zip
City/State�Lip $ /" C-
'Z,_ L Thy — Telephone Num er/emal dore4s
Telephone Number/email address
,1 �.� _
12

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RECEIVED
JAN 0 G 2921
DCM-MHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ `� ` Namg of Property Owner)
property located at
on
(Waterbody)
(Address, Lot, Blno�kyRo A .) ` / N.C.
in l/�/ �t'vf,=
(city/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
y_ 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)
g -e to -t- -e;-k I 5'7�D 6
WAIVER SECTION groin
boat ramp, breakwater, boathouse, lift, or
I understand that a pier, dock, mooring pilings, avian access unless waived by
area of ri
must be set back a minimum distance of 15' from my P
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.
(AdjacentPro,y Owner Information)
(Property Owner Information)
--�- Signatu
Signature__
", Print or Type a�!e
Print or Type Name �� �� /�r/r!`�/c
2 4100 X'" `f `�� Sf Mahill,gg ddress %
Mailing ddress , �, >"7 -I A'.)- �_
/ 16r H rt' C/� , City/Stat�lZip _
City/State/Zip C.
-Zs—L y Z y b Telephone Num er/ema I d ens
Telephone Number/email address
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