Fielman, Megan 78377C

.-. �*AMA / ❑ N9 '%7 DREDGE & FILL 3
1 � r 7 A B C D
ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality O�
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
ules att hed.
Applicant Name Project Location: County
Address X Street Ad s tate Road/ Lot #(s)
City State 1V(7ZIP
Phone # ail Subdi 'sion
Authorized\AVI
gent \ �j'City ZIP
Affected WW y TA ❑ ES LIP TS Phone # River Basin
AEC(s): ❑ OEA HF InI ElUBA [I N/A Adj. Wtr. Body nat man /unkn
❑ PW .
ORW: yes / Ph PNA yes / o Closest Maj. Wtr. Body
Type of Project/ Activity 1�
Pier (dock) length C�J
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap lengt
avg distance offshore
max distance offshore`
Basin, channel
�V_
cubic yards`—�
Boat ramp
Boathouse/ Boatlift'
Beach Bulldozing
Other I A
Shoreline Length _
SAV: not sure yes no --
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes n —
A building permit may be required by:
( Note Local Planning jurisdiction) -Y
or Aodlicant Printed Name
** 1�IRase read compliance statement
OU
Fee(s)
"A
Permit fic is Pri
)ack of permit Signature
heck # Ve
(Scale: 11 )
❑ See note on back regarding River Basin rules.
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 (252-946-648 I) 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
Name of Property Owner Requesting Permit. -U4
�n
Mailing Address: I V W G 1I bx k
�C.?
Phone Number: Z'52 r� "I ✓ ����
Email Address: hAtkA' TttVIA a^e' S h"L'�'
I certify that I have authorized
Agent/ ontractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �e �U �`�)U(.
at my property located at
in Ca'[ 1 County.
P
/ furthermore certify that / 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
�A,L A P1 A 'r, 4, �
Prik or Type Name
Title
_(/ ( I /—
Date
This certification is valid through
(,k cK)
RECEIVED
JAN 2 0 2021
DCIM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to WIk s
Name of Property Owner}
property located at `� 1 � l�'/�1� � � �iGk-
on �J��h �� �( ,/ (Address, Lot, Blor,, Road, etc.)
in 1�� r' c(,0 4y,i % , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
KI 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 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 Information)
� v "
Signatur
Print or Type NaMb
Mailing Address 'x o
City/State/Zip 2-
,� 2 24 ( a
Telephone Number/email address
Date
(Adjacent P, 7e,'t, Owner Information)
a �
Signat 9 e `
lP 1'e
Print or T��yy e Name
z2p z
Mailing_ ddres�s,�l
l (/A I
Cityls 1P ,
Telephone Wmber/email address
Jap 2D- -1
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to M\ stirs s
(Name of Property Owner)
propert located at 2 �I� l,Zl/tWl� �p���-
(Address, Lot, Block, Road, etc.)
on NOVhn 2WU , in L H v f ; i,- , N.C.
(Waterbody) (City/Town and/or 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 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 Information)
Mk�, AAA-,,
Signature
�Lxu, <&N e 12
Print or Type Nam
Mailing Address !�
L=9t�Sl4'
City/State2ip ,—
Telephone Nu m er/e ail address
Date
(Adjacent Property Owner Information)
Signature*
,-=5o t"i M W-1
Print or T pe Name
0-C)
Mailing Addr 14s
City/State2ip
Telephone Number/email address
L.-- 4- 1 %,
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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