Bizzell, William 80457C

AW I YJ ORSOCS & PILL
! ENERAL PERMIT
ew CMadification OCoTplete Reissue Partial Reissue
As Aut led W the State of North Carolina, Department of Envito.mmal C..ol Rawrces Comm mw Q-11z 'Wan in aD Aof any5ronm."tal comem
NO 80457 A 8 iie"Nvo
Previous permit #_ [
6ati Srmit issued
to I SA NCA,'

rAMA / ❑ DREDGE & FILL T 9 804557 A B C
ENERAL PERMIT - Previous permit#
ew ❑Modification ❑Complete Reissue El Partial Reissue Date pre i s ermit issued
As autho zed by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in area of environmental concern pursuant to 15A NCAC
Q (I p61❑ R es attached.
Applicant Name 11 IL `C.'�Project Location: County
Address '� Street Address/ StIte Road/ Lot #(s)
CitynAzent
ate ZIP/ 41214 an.0
Phone !A&
l ubdivis' n /�
AuthoriAIAAA -A 1;J4 IP rY
Affected ❑ CW n W EITA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HF ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / rf6 PNA yes /
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(st--
Groin lengtlr ---------—
number,
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel---'
cubic yards
Boat ramp e
Boathouse/ atlift
Beach
Other
Shoreline Length
SAV: not sure yes o ..- -
Moratorium: n/a yes o
...........:...
Photos: yes no
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning jurisdiction)
Ndtes/ Special Conditions
Applicant
❑�C
Si nature *** ase read compliance statem t on backof
pplication Fee(s) C ck
Adj. Wtr. Body
Closest Maj. Wtr. Body
Permit
—/, WMer Basin
(Scale:) )
❑ See note on back regarding River Basin rules.

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
Iandowner(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 consistentwith 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 complywith 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 CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
Mailing Address:
Phone Number:
y
/ -L
Email Address:
I certify that I have authorized T
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �"7,T7f—
5 �.
at my property located at
County.
1 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:
Print or Type Name
',// , / � � 455:� 4-Y-- 7 /--\
Title
q
Date
This certification is valid through % / i / �
RECEIVED
JUN 16 2021
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Zt/' J,(. �,,,, dah"--t
�
(Name of PropertyOwner)
property located at f y Dp l /l on/� f`��,P r
-� (Address, Lot, Block, Road, etc.}
on �4v,rG. _f11411 in f )a,r 7L1' (- 5e6 ,7f?.- N.C.
(Waterbody) (City/Town an or County)
The app ' has described to me, as shown below, the development proposed at the above
locati
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)
';'
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MIVER 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 yob wish to waive the setback, you must initial the appropriate blank below.)
VI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop ner Inform „ierr3� (Adjacent Prop Ow Information)
Sigtr S.
• t e *
Ly.:/�/ fO/
Print or Type Name Print oar Ty e/NN
Mailing Address Ma ' g Address
ESo
City/State/Zi ci /state2i
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Tel p ne N tuber email address «r �u!'r�,Telephone ber email address
zo
2 z�
D e Date*
(Revised Aug.j�IVE®
*Valid for one calendar year after signature*
JUN 16 2021
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1 l 67,,w
,f �� ► Z z l 's
property located at (Name of Propet Owner)
(Address, Lot, Block, Road, etc.)
in f a,r ,' C ��. ► N.C.
(Waterbody)
(City/Town an or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
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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.
(prop Owner Inform-atiorTj` (Adjacent PropertyOwner Information)
�+Y
Signe Siatlrre
urt
Print or Type Name )J �Lr/i/t�or 7g/p+e�Na e
L�Lcr1l In l Yl S1�P
Mailing Address Mailing Addre s
City/State! i City/State2lp
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Te! p ne N mberlemail address `dn,Fh,�,,,��Telephon Number/ mail addressV�
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RECEIVED
'Valid for one calendar year after signature' (Revised Aug. 2014)
JUN 16 2021
DCM-MHD CITY

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
Mailing Address:
Phone Number:
/ 1�
r-i
74--
7;K,_ r �� -e-rl- c
Email Address: y_
I certify that I have authorized AeArZA.A.
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all JCAMA permits
necessary for the following proposed development: �el �� /r� �- f4
at my property located at
i ��74-- County.
S,
g� C'
1 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.
Grnnarty nwnar Infnrmatinn_
Print or Type Name
—�—'f Tifle
')(Mck)
Date
RECEIVEDThis certification is valid through l / I ' I
JUN 16 2021
CCM-MHD CITY

y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Z!/,'LJ. a f l a�pr� ��r
D (Name of Prope Owner)
on/� property located at (y D /f le. � ' z x '/N
(Address, Lot, Block, Road, etc.)
on l v �? f�yH �y , in � ' C iao �ems. ��i .,-,-/" N.C.
I� C , tr
(Waterbody) (City/Town an or County)
The appi' has described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDlOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
,7:7GP / wR a� 7` � y �'� y� r/ Q �d4 'J '5" u/cu 7�
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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 yo wish to waive the setback, you must initial the appropriate blank below.)
V- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop miner Inform�ienj"f (Adjacent Prop Ow Information)
M. siti
Print or TypeName ' / Print or T/y�e Npme
/
Mailing Address Ma" g Address
/G "0 s�: , f/mac- r S- /1/tq is Ale Z 76, /
City/StatelZi Ci /state2i
5�.�z l - / �� (� I ,•� x � � yai � �
Tel9ptpne N mber/email address 'CG`771 v"'" ,Telephone ber email address
OIL
2 z�-
Dbtle Date*11
(Revised Aug.I VE
*Valid for one calendar year after signature*
JUN 16 2021
L)CJM-MHD CIITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to - l/ i Z—y,F ,s
property located at 1 y p (Name of Propertv Owner)
e/` .
(Address, Lot, Block, Road, etc.)
on i �- v �. fr�v� r ; in ee, �� i?h �fC.N.C.
(Waterbody) (CityR'own an or Couniy)
The applicant has described to me, as shown below, the development proposed at the above
location.
r-' I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndivid Jai proposing development must fill in description below or attach a site drawing)
tf,3�S 7"
5rcr2 cJ
SEo /a, c e Cl
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.
trrope Owner Inform (Adjacent Property Owner Information)
Sign e Si�1<1 ralui e
Pnnt or Type Name Pri t�rpbe Na e3 �� 3 /��-�,��, l! sx,sE 11C, �, s
Mailing Address Mailing Addre s
17
Citylstate'qCity/State/Zip
Te! p one N mber/email address �Tel� ph nNumber/email address
e
_- _
mate*_
�RECEIVED
`Valid for one calendar year after signature` (Revised Aug. 2014)
JUN 16 2021
DCIA-MHD CITY

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