Pate, Tim 79647C

CAMA / ❑DREDGE & FILL N9 79647 A B D
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue , ❑Partidl Reissue Date previous permit issued
As author, ed by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commissi in an rea of environmental concern pursuant to I SA NCAC
/� —1�� Rulepps atta ed.
Applicant Name Project Location: County CGAX4 D i
Addres etAddress/�Sta e Road/ Lot
City State ZIP
_ .... A
Phone # -Mail
Authorized Agent
Affected ElCW "LEW `�yT'PTA ❑ES ❑PTS
AEC(s): EUEA HF M ❑UBA ❑N/A
❑ PWS:
ORW: yes /no PNA yes / r
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Pr((s !�I
Finger pier(s) � I
Groin length
Bulkhead/ Riprap length
avg distance offshore
max distance offshore I
Basin, channel'. -1 -- �-
Boat ramp,
Boathouse/
Beach Bulldozing �
Other lfV%O.ALfXnOCY rvvun.l , d
71�j �Wv"
Shoreline Length 0(0
SAV: not sure yes
Moratorium: n/a yes o
Photos: yes o
Waiver Attached: yes '7
A building permit may be required y:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
n
ent or Applicant Printed Name
Si ature • ase read compliance staterrje ton backof permits"*
pp 'cation Feels) Check #
Phone # "i
Adj. Wtr. Body
Closest Maj. Wtr.
ZIP
Date

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 ❑
❑ 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/I-888-4RCOAST
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: Ti V 1 a�<t I
Mailing Address:
Phone Number:
Email Address:
i 1- I -r A, 4 ir- K n nl D G.2 I r�
2Z�.5
itl rz N r W C u'n5 n:G. 4- 7—
.5'�-- 3 b I + �! /o
I certify that I have authorized I:, q V^' V`� L`� ``5
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: P ( I
c�B(2 9L:1 � t �
at my property located at '-f 0 a
in C ^tCounty.
I 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:
'All I
Signature
Print or Type Name
Title
r I 2- P3 1 1 I
Date
This certification is valid through
�d WDO
c� 1-I5d a
RECEIVED
MAR 22 2021
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Narne of Property Owner:
Address of Property: � U D I � N I-C.'.
(Lot or Streets#, Street or Road, City & County) r 4
Agent's Name M !' 91-' F'V EC' `(S Mailing Add ess:
Agent's phone#: �--5��-`1�5-/`z/ �'_ !`"IOFC�'
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. R NTiib'i�n"`fo l V i` i i'09`r's on t us b `[ vrd1)il'with thisletter.
X f have no ON ctions to this proposal, I have objections to this proposal.
SEE NOTE 1 BELOW
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. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557, DCM representatives can also be contacted at (252) 808.
2808. No response !s considered the same as no objection lou have been notl/lod by Certilied Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a rninimum 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.
oryP I do not wish to waive the 15' setback requirement.
(Property Owner Information)
r—
Signaiure
�.a►n-t Pro, art +Nner Information)
S' nature _ r�
Louis J Pagano
Print or Type Name
2000 High Wickham Place
Mailing Address W
6 C''C-c rJC Louisville, KY 40245
City/state2ip City/stateQip
[phone]
Telephone Number Telephone Number
_3P, --
Dare
3/1812021
Date
RECEIVED
Revised 6/18/20MAR_$ 8.2021
DCM-MHD CITI

NOTE 1:
We have no objection to your proposal provided the actual pefmit drawings still show the dock in
the hand drawing and it is a minimum of 140' from our property line and no further than 200' out
into the water. It also assumes as we were told by you that this dock will only be used for private
boats and no commercial boats or boats for hire. Also we have not waived the 15' set back due
to the fact that it should not be required according to the plans,
RECEIVED
MAR 2 2 2021
DCM-MHD CITY

I
I hereby certify that I own property adjacent to
properly located at t ')
(Address, Lot, Block,eC 1 .C.
on (/ �' sp Vy C ' inITown a for County)
(V1laterbody) osed at the above
The applicant has described to me, as shown below, the development prop
low on osal.
d c4 I have no objection to this prop --
I have objections to this.pMPasal-------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill In description below or attach a site drawing)
�tV klVER SECT10N .
_ I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin comet If You
area of riparian =M unless waived by
back a minimum distance of 15' from my
wish to waive the setback, you must initial the appropriate topUelow.)
_ I do wish to waive the 15' setback requirement.
^-M^ -N' t wish to waive the 15' setback requiremert-
I do no
-------�-�'�"---��-�.e..—��.— Information)
(Property Owner Information)
S[gnRf)�rA
Print or Type Name t P4
4.1-7 A LE7-Aisne--
ity/3I-
Telephone Number
1. z e8
oars
(Adjacent Property Owner
2-1
N
Date RECEIVED
MAR 22 2021
0
4:;vised 8/18/g012)
DCM-MHD CITY

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