Geer Family LLC 79641C

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NCAIVIA REDGE & FILL A 8 D
ENERAL PERMIT Previous permit #
w ew i_ Modification Complete Reissue 7Partial Reissue DateWRule,
ed
As authorized by the State of North Carolina, Department of EwAronmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 1510,
NCAC _
hd
- �aw tlon: Count. . ...... _...... __..
Applicant Name ...... m .. _ ..
A.,-f—' _ � _ t _ StreetAddressl Stag Road( Lot #(s)
Poe read comphance statement on track of permit
! _.. _
6ee(s)
heck #
1; `t
naps:Ilmail,google.comimaiUul01?tab=rm&ogbi#inbox?projector=1

MCAMA / REDGE & FILL A B t/ C� D
ENE L PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Da e r vious perm' ed
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I NCAC
L, j $41 Rules att hed.
Applican4Nam�e-,F—f�nv'kAj ��.��. ct cation: County9Address/� 1 �L StreetAddress/ State Road/ Lot #(s)
CityState IP
Phone # — E-Mail "—� Subdivision
Authorized Agent%,,
❑ CW W 'PTA
ES ❑ PTS
Affected
❑ OEA ❑ HHIF d II
❑ UBA ❑ N/A
AEC(s):
❑ PW .
ORW: yes / n PNA yes /
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platfo m(s�_
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
ax distance offshore
B sin, channel ANIVVY (r,
cubic yards ' V°
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other 11
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
r
A building permit may be required by:
( Note Local Planning jurisdiction)
Note Special Co ditions
or
City-4 r rV1 V�N
Phone # �)
Adj. Wtr. Body
Closest Maj. Wtr. Body
If
ZIP
Basin
0
(Scale: )
c
See note on back regarding
Basin
Signature ** R e se read compliance statement on back of permit" Signature
Z4� b�
Application Fee(s) heck # issuink D<
ration

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 I) 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 (910-796-7215) for more information on howto 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/ 1-888ARCOAST 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: C� �wrr►• 1� �.. �-
Mailing Address:
Phone Number: `LS 3�
Email Address:���
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: t✓t-C
at my property located at �0 1i
S�
in (�,A( u-J County.
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.
Property Owner Information:
1L_'
ut_'U,� .J
Signature
"on)o U
Print or Type Name
Yr C-LJ t4- - -n r r V C r
Title
4 I r z I rL t
Date
This certification is valid through

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
,
rntx-<\AY 4CS ��
I hereby certify that I own property adjacent to Name of Property Owner)
property located at CJ'4rS
(Address, Lot, Block, Road, etc.)
—_, N.C.
n 1(-,A (� r�- i
on ort�c� in f- �n _ I�Y1 - (t�(aterbo y) (CitylTown artdiar County)
��y�
as shown below, the development proposed at the above
The applicant has described to me,
location.
I have no objection to. this proposal.
_ I nave ob-j-ecti-onso tUS_proposal.__--------
-- DESCIR PTION ANi OR DRAWING of PROPos�low DEVELOPMENT
a srfe drawing)
(Individual proposing development must till In descrfPVC)n
WAIVER SECTIONor _-
- - I understand that a pier, dock, mooring pilings, brest be set
aka aareira�ess unlesousesftwa waived Eby mue. (If you
back a minimum distance of 15 from my area of rip
wish to waive the setback, you must initial the appropriate blankbelow.)
I do wish to waive the 15` setback requirement.
► IA I do not wish to waive the 15` setback req
uirernent_
—� (Adjacent Property Owner information)
(property Owner Information) n in ^ A
Sib atu�e
Pant or Type Name 51- y—
Maiiing Address 1 h 1 C SS
'n'Md
City/StatelLip
2.-52
Telephone Number
_J at a
Mailing Address
city/statelLip k
a d 7,►G
Tel ephone 3um baer
Date
(Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT r
b t' c-�� sq u YJ-)L°iC�K Ss
I hereby certify that I own property adjacent to a Owner)
(Name of Prop
property located at 3 w 1 - v a r1 S 4 .
(Address, Lot, lock, Road, etc.)
on m ©r��, " C �� C in _ > s " -
(Waterbody (CitylTown andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location
✓1 have no objection to this proposal.
I have obj_ectLo_n5do ttds-prQposaL—_--------
- --- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEL�OPMNT
ta h a site drawing)
(Individual proposing development must fill to description below
WAIVER SECTION
- I understand that a pier, dock, mooring pilings, breakwater, l3athouse, 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 trust initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
N lk I do not wish to waive the 15' setback requirement_
(Property Owner Information) (Adjacent Property Owner lnformation)
Sibnature Sio atur�
Print or Type Name Print or Type Name
I b S 5, -)-OnSA-
Mailing Address Mailing Address L 2-e'5 5-1
iYlorb�cbvJ C� (�C �355� NorL�rAo C �
CitylState/1ip Cifiy/Statelzip d -7 D 5-
252 ,3y2- 253 � 3y2-
TT9lepnone Number
Telephone Number
`A-
date .date
(,4evised 6/13l2012)

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