Ezzell, Gordon 78289C

13CAMA / I _; DREDGE & FILL N9 78180 A B CCD
ENERAL PERMITPrevious permit #
ew Modification ' (Complete Reissue martial Reissue Date previous per ms%a sued RI
As authorized by the State of North Carolina, Department of -Environmental Quality J
and the Coastal Reso es Commi lion in an are f environmental concern pursuant to 15A NCAC
ules, ached.
Applicant ame �-� Project Location: County--�
Add r s - to Road/ Lo��s)
Street Address/
City - at ZIP
Phone #C64 -M il,— ___�_.__... Subdivision
Authorized Agent City _ ZIP
Affected ES J PTS Phone #p�j _ River Basin
AEA
W1, TA�J IH C, UBA LI N/A
�HHF
AEC(s): Adj. Wtr. Body an unkn)
_..1 PWS: _ - -
ORW: yes /[np ) PNA yes r o n Closest Maj. Wtr. Body - Q
Type of Project/ Activity at�--�
(Scale: )
Pier (dock) length) --
Fixed Platform(s)
FloatingPlatform(s) --�
Finger pier(s)_:.
Groin length � - i
r 1
Bul hea iprap length
avg distance offshore `
max distance offshore
_.
Basin, channcL_ .—=
cubic yar'dr'
Boat ramplab
Boathouse/ Boat, -,-
Beach Bulldazing�� ,
Other__ Q
Shoreline Length _ 100 (';e /
SAV: not sure yes o
Moratorium: n/a
Photos: yes no Waiver Attached: yes no - -
A building permit may be required by: See note on back regarding River asin rules.
( Note Local Planning Jurisdiction
NoteASpecial ConditionA Lgi2 I ayme�A
Agen or Applicaanr�iotr�fJame Perri it Me r' Pri ame
rgnature _lease read compliance statement on b k of pe it Si u
Application Fee(s) QChec Issw a�

*AMA / ❑ DREDGE & FILL N9 78289 A B (C I D
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous perms J sued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resou es Commi sion in an are f environmental concern pursuant to 15A NCAC
Rules ached.
Applicant ame Project Location: County
Addr s Street Address/ S to Road/ Los)
City at ZIP
Phone #A -M il, Subdivisionm__
Authorized Agent
AffectedAlEA
W ,\I
AEC(s): ES El PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: _
ORW: yes /(n� ') PNA yes
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) `-'-
Floating Platforms)
Finger pier(s)
Groin length
Bul hea iprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards----'—�
-- --_._.
Boat ramp
Boathouse/ Boat
I
Beach Bulldozinll�
Other
Shoreline Length
a® _
SAV: not sure yes o _..........
Moratorium: n/a yes n
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: _
( Note Local Planning Jurisdictiont
Notep/,Special Condition T�lu
Agen or Applicant Printed Name
ignature _lease read compliance statement on b k of pe mit
t4W�(��
Application Fee(s) Check #
City
Phone #
Adj. Wtr. Body--lA
Closest Maj. Wtr. Body
ZIP
Basin
1 �-
('Scale- )

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 [)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 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

47
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C, Davis John E. Skvarla, III
Governor Director Secretary
Date P-//o/c')
Applicant Name /
Mailing Address � 7 7, S d � %
52
I certify that I have authorized (agent) j c C� " ` `
��___ to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
— � /�" AV(� C/ , at (location)
a $ y o0
This certification is valid three (elate) j 11 //0 �� CA
Signature
RECEIVED
400 Commerce Ave., Morehead City, NC 28557 One
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagem 1 �, 2021 t NorthCarolina
An Equal opportunity \AffiirmativeAction Employer DCM-MHD CITY Natk d4

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4srclo - 'z�2 ( s
(Name of Property Owner)
property located at r 1 � V
(Lot, lock, Road, etc.)
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on on in w- i
(Waterbody) (Town and/or County)
Applicants phone th 90 ;P Mailing Address:_
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
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(Information for Property Owner Applying .(Riparian Property Owner Information)
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Mailing Address Signature
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City/State/Zip
-' Print or Type Name
Telephone Number Telephone Number
/ Signature DaIRECEIVED Date
FEB 12 2021
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Ida- j C 1-ZFI/ s
(Name of Property Owner)
property located at ✓�
(Lot, Block, Road, etc.)
Oil Zc.Ic-ti W4/"� L /L;c`4�1{= N.C.
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(Waterbody) . (Town and/or County)
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Applicant's pho e #: Mailing Address: 9 `� Zt �
He has described to me, as shown below, the development lie is proposing at that location, and, I
have no objections to his proposal.
-----------------------------
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
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(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
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Signature 2 2021
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