Parson, Scott 80440C

City.._.: _ ZIPS
Phone # r River Basi _. Rt
Adj. Wtr. Body _ l
_ (q4t man. LUNI
Closest Maj. Wtr- Body
a'D
I J E G FILL 0 A B
' GENERAL PERMIT---- Previous permit #
New =..Modification iCampiete Reissue 'Partial Reissue Date pre, io permit iss ed} _
As autho ized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Co issio an area of environmental concern pursuant to i SA NCAC� ules attac
Applicant Name Project Location: County_.. ...---.......
Address Street Address/ S ate Roa I Lot #(s) _
_-�. -
_.. -..._ _ ZIP9Z5_ `-_1%—CiyMate d._
Phone #
Authorized Agent_,_J-_ ...
L CW ?-EYV P fA ES -
Affected o&A HHF ii i 'USA ` A
AEC(s):
RW- yes / Wo i/ PNA yes
Type of Project/ ActivitY
A. building permit may be requir by: m! _ ' See note on back regarding River Basin rules
(Note Local Planning f urisdiction
es/ Special Conditions•
Ell
.. .. ._ V.
AV br A(� nt ri a Permit r s ri Name
f
_
cif permit Signature
S gnaa,re * P1 e read compliance statement on back # 8
jj pg ,
Check # isut�
Ap� plic�tic,n sec:{s3

OCAMA / ❑ DREDGE & FILL
ENERAL PERMIT
New ❑Modification ❑Complete Reissue El Partial Reissue
authoed by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Co issio'(pyn�'\'Lan area of environmental concern pursuant to I SA NCAC
\\ /'. n ...t _, 1
Affected ❑ cw
AEC(s): ❑ OEA
❑P
ORW: yes / o
9 80440 A B CC
` D
Previous permit #
Date previous permit issued I _ _
Project Location: County
Street Address/ State Roar
Subdivisio
City_
Phone #
T6;
Adj. Wtr. Body
Closest Maj. Wtr. Body

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 (910-796-72 15) 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/ 1-888-411COAST 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 COAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:.
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized YAM, CA', IDS'". -i
- - - - 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: (G)
n
at my property located at Z( 7�7r c_ E eo,-
in County.
1 furthermore certify that l 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:
V t Signature
Print or Type Name
0t,%NO (k)
Title
—1 pal 1 i RECEIVED
MAY 19 2021
This certification is valid through 11 l�_I Z Z DCM-MHD CITY

AWACENT RI,QA tJM PRiY gTy OWNER STATEMENT
I hereby certify that I own property adjacent to !&eg3t `�r nxm- 9 's
(Name of Property Owner)
property located at 7 1 -Z
(Address, Lo Buck Road etc.)
on -y''�t C. in 1 e< �-; c ct - N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
V!-00
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING Of PROPOSED DEVELOPMENT -- -
(Imtavldual proposing development must fill in descdpdon below or attach a site drawing)
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.)
hair I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Props r Information)
qal
Signature
Print or Type Name
Mailing Address r%)e
Telephone Number
-'� ?-Z�
Date
information)
f-mr or f NarT7
l eo /�o x id i '7
Mailing Address J r'6
i -A
Telephone Number y a DECEIVED
Date MAY 19 Z021
(Revisod Warial2)
DCM-MHD CITY

Zfr
F,1k,7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �/�"rit s
(Name of Property Owner)
property located at r
(Address, Lot, Block, Road etc.)
on 'SO in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
- locatign.�
c'--> >/ 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, 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.)
64—
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
�C �.}•f �r � e;, .vim `>
Print or Type Name
C.- :y�. �lnrlt V)r'-
Mailing Address
City/StatelZip
Telephone Number
Date
Adjacent Property Owner Information)
Signature_
Print or Type Name
Mailing Address
City/State/zip
Telephon'b Number RECEIVED
Date
MAY 19 2021
(Revised 611812012)
DCM-MHD CITY

E
C) C�)
"ON
(-I -- - f-21 .
RECEIVED
MAY 19 2021
DCM-MHD CITY

Jlk
0
A-11
RECEIVED
MAY 19 2021
DCM-MHD CITY

'��•",;: "ate
N 4t m
N 3 i
G
U 2 .Z
� a
IN
t�
�yy r I- m rn
,I
I
a$
3a
— E
E c
y
z �4i n u 8-2
i 3 o o E
�Uc
d N N �°
00 a
00 00 p o E m
N ~ � cq a
O N $ as
O w w O N ti
O
N V] y, m y y
E
Cl) "
4. E o n as a
Rt H oo x A
0 4 U ���-,+ Q co
ON co dim
C V Z O Z a uxa o �_
�i Z" cox W '�, O U N oo p p 8 r
00
CO co iD
vfj
in o
Cyr 4 o z o N c. a A
H O M N¢ N a s w F H a H m A a, A €6.

T
m
w
cn
m
m
w
0
(D
0
l<
0
c
m
0
0
Q
0
0
0
-0
w
l<
3
(D
c
0
m
3
N
C
(D
Q
D -0 JJ
o 'a (D CD
. 3 (D
<
D (D
a It 0 a
a (n .. -n
z o
(n
3 l
m �
it -A
z
0
n <
� :
cD
O
00
O
0
(D
n �
cD DJ
� CO
.+ CD
3
(D
O 3
0
X
z (D
O
co
N tt