Perry Grandchildren, LLC 79630C

LAMA / DREDGE & FILL -N 9
ENERAL PERMIT Previous permit#
ew IModification ' ;Complete Reissue iJPartial Reissue Date previous permit issued
As author zed by the State of North Carolina, Department of Environmental Quality r)
and the Coastal Resources Commission in an area of enviro mental concern p rsuant to I SA NCAC/
� ,o _ _® alas atta ed.
Applicant Name_ --- `V� - �✓ Project Location: County-
Address _ Street Address/ State Road/ Lot #
City- - State IP—
L -
Phone # _ ��..E-Mail--.._—._ Subdivision --
Authorized Agent .. _ ZIP_
r -- --- -�'Y�� "v- ��1.. City_ -
'�tt1n! _ TA DES Es _ PT5 Phone # _ _ _. Riv r Basin
Affected __ �+�
AEC(s): ' OEA I HHF C H C UBA NIA Adj. Wtr. Body a an junkn)
PWS: 1
ORW: yes 1 r o ) PNA yes 140 Closest Maj. Mr. Body
Type of Project( Activity
Pier (dock) length V
FixedPlatform(s) 141)4i jtX�Di�
Floating Platforms)-�
Finger pier(s) 3/1v�
Groin length _.
number
Bulkhead/ Riprap length
avg distance offshore..
max distance offshore
Basin, channel
cubic yards --t+ —
Boat ramp
BoathouselBoatlift �..
Beach Bulldozing'-_, -_ -
Shoreline Length I -A,J..-
SAV: not sure yes o
Moratorium: rVa yes io
Photos: yes
Waiver Attached: yes ro
A building permit may be required by:
mal
( Note Local Planning jurisdiction)
Notes/ Special Conditions
' IIV y (Scale: 0 )
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4�r✓.�.II.__L:. �---`�—,--taus.! `-� c---_ _.�.__�._
or Appli nt anted Narn f
ire a'+P read complian statement on back of permit ak
f �Q
ation Fees) Check ✓±
Permit
S'ntre
Iss n bate
backrepardinR River asin rules.
� VDate
pira i

AMA / ❑ DREDGE & FILL N 79630 A B D
ENERAL PERMITPrevious permit#
ew El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of enviro mental concern p rsuant to 15A NCAC
ules atta ed.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #
City State 3n. IP,
L , P_ qa
Phone #, � E-Mail Subdivision
Authorized Agent City _ ZIP
Ww TA ❑ES ❑PTS Phone #� �' Riv r Basin
Affected ElOEA ElHHF ❑9H ElUBA El N/A AEC(s): Adj. Wtr. Body na an /unkn)
❑ PwS: C
ORW: yes / o PNA yes 16 Closest Maj. Wtr. Body
Twe of Proiect/ Activity iYUA \
Age t or Applicant Printed Name
S' ature "�R)n'Ou
jergse read compliance statement on back of permit
Application Fee(s) Check #

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 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(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: Peir 7 Vra,.<J,4 L L C
Mailing Address: o 10, IItI
1nSiail, /V L �5C 3
Phone Number: Z S 1- 5 2 SZY Y
Email Address: C. C'9�
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Ca, S f/-e, C / 19/1
at my property located at Z/ g1l) 5- ii pn '„'e
in /�� County.
l 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:
Signature
Print or Type Name
Title
% /�' ���/
Date
This certification is valid through 9 / I 12� 2

Q
u
0
e

■ Complete Items 1, 2, and 3. A. Signature t
i Print your name and address on the reverse X �P ❑ Agent
so that we can return the card to you. C] Addre
■ Attach this card to the back of the mailpiece, B. Received b rin Name) C. Date f D
or on the front if space permits.
1. Article Addressed to:
��"j
II �'III'I III ICI I IIIIIII �IIII�I I II IIIi l I II I III
9590 9402 5357 9189 7559 69
2. Article Number (Transfer from service label)
ru
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ru
a
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C3
0
C1
C3
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C3
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D. Is delivery address different from item 1? 13 he;
If YES, enter delivery address below: p No
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
0 Registered Mallm
0 Adult Signature Restricted Delivery
❑ Reglster Mall Restricted
❑ Certified Mail®
Deliveryed
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
0 Signature Confinnatio04 .
Signature Confirmation
cted Delivery
I
WW❑
Restricted Delivery
Domestic Return Receipt
Postmark
Here
,P
01 / 28/ 2021
V.�,.POSTAL SERVIG
MOREHEAD CITY
3500 BRIDGES ST
MOREHEAD CITY, NC 28557-3095
[phone]
01/28/2021 12:1
Product- — — Oty Unit
Pri Ge,
First -Class Mail@ 1
Letter
Morehead Citv, NC 28557
Weight: 0 lb 1.10 oz
Estimated Delivery Date
Mon 02/01/2021
Certified Mail@
Tracking #:
70190140000102293182
Return Receipt
Tracking #:
9590 9402 5357 9189 7559
Total
First -Class Mail® 1
Letter
Morehead City, NC 28557
Weight: 0 lb 1.10 oz
Estimated Delivery Date
Mon 02/01/2021
Certified Mai10
Tracking #:
7019OJ40000102293199
Return Receipt
Tracking #:
9590 9402 5357 9189 7559 1
Total
Military Dogs Bk 1 $11.00
Bugs Bunny 1 $11.00
Healing PTSD SP 20 $0.65
Grand Total:
Debit Card Remitted
Card Name: VISA
Account #: XXXXXXXXXXXX1502
Approval #
Transaction #: 202
Receipt #: 017556
Debit Card Purchase: $49.40
AID: A0000000980840 Chit
AL: US DEBIT
PIN: Verified

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: � l% �� r� ��� &", 4 z
Address of Property: F6) � '51, f ✓J/ e lq)�ek-"c/
r (Lot or Stree #, Street or Road, City & County)
Agent's Name #: 11M 0kJ-00L, Mailing Address: ill
Agent's phone #: 25Z-725 3Z2-j 4o±k,c Cd AL- AV5 7
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
-�41 I have no objections to this proposal
_ __ I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastalmanagemetit.netlweblcin/staff-listinu orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
Q-7,k-1 do not wish to waive the 15' setback requirement.
(Props O er
G/
Signature /
19el
PP t or TZpeame
X �s
Mailing Address
5 orlr N C
City/State/Zip
Telephone Number/EmailMregs
Date`
(Riparian Property Owner formatio
Print or Type Name c
y?l2 S
Mailing Address
City/State2ip
7
Telephone Number/Email Address
C;2- �= �
Date
(Revised Aug. 2014)

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