Adams Harbour 79650C

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Application Fee(s) heck I suin

CAMA/ El DREDGE & FILL
EN ERAL PERMIT
Previous permit #
ew ❑Modification [-]Complete Reissue
❑Partial Reissue Date previous permit issued
As authori ed by the State of North Carolina, Department of Environmental Quality
and the Coastal Re ur es Commission in n rea of environmental
concern pursuant to 15A NCAC `
lees ed.
Applicant Name
7%�p
Project Location: County
Address
Stree Acl ress/ Stat Road/ of #(s)
City
State YV ZIP�)M
Phone #
E-Mail �-�"
Subdi isi n MW
Authorized
City
ZIP
jAent
AffectedWEW PTA ElES ❑ PTS
Phone # River Basin
AEC(s): ❑ HF I ❑ UBA ❑ N/A
Adj. Wtr. Body I/ (nat
man /unkn
❑ PW
ORW: yes / n PNA yes /�
w
Closest Maj. Wtr. Body
• n
Type of Project/ Activity
Pier (dock) length - V 1
Fixed Platform(s)
Floating Platform(s) -
Finger pier(s)
Groin length- -
number
Bulkhead/ Riprap length
avg distance offshore �!
max distance offshore
Basin, channel
mr-Y
cubic yards
Boat ramp ---
Boathouse/ Boatlift
or Apkicant P�iritecraamer f r J Permit
lure ` lease read compliance statement on b of permit �/ Signa urUY
ication Fee(s) heck# Issuin a e Expirat n 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, certifythat 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 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/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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

I hereby certify that I own Property adjacent toq(A, _60000A641) --IS
Property located at Q.06C)
Ac (Name of Property Owner)
�Q
on (Address, Lot. Block, Road, etc.)
kL in N.C.
(Watertbody)
(Cityrrown and/6f 6o unty)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal,
1 have
ve objections 10 this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual Proposing development Oust fill in de-scdPOGn below or affach a site
drawing)
U,
J
L
WAIVER SECTION
un( Jerstand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin V
aiust be set back a minimum distance of 15' from my area of riparian access unless waived by
(if you wish to waive the setback, you must initial the appropriate blank below.)
I do
do ffo-T i �8'
(Property Owner Information)
A
PY, or Type .. ame
AB iting 'Iddre-
6k;
cilylstatemp
Z-5
Telephone Numberl email address
19( We
rlfvl*��_. '2- l 2, k
(Adjacent Property Owner Infor
k 1-2
Sign
17� A.
Pri, TyVEXpe NaIV, '�-
Uill 09 Addrem
Ch rYSIata(Zip
7'elephone Number/email address
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