Jacobi, Charles 78281C

1 /26/2021
Image (252),Ipg
AMA / 11 DREDGE • FILL
4autho
ENERAL PERMIT Previous permit#AB D
ew iJModification ]:;]Complete.Reissue [.]Partial Reissue Date previous rmit irwed
Asd by the State of North Carolina, Depdffment of Environmental Quality
and the Coastal ftesourc s Cor m isslon in an ea of environmental concern pursuant to I SA NCAC
, Rules �tr Mtr'
Applicant Name. j_..__ _ Project Location: County.
Address ` _._ _ _. _._. _ W((,_ ._.jj Street ess/ St
epR�oa Laj (s)
City _ StaIP G_�_I..i....,`_/'!` tz✓?.1_.....iw
Phone #_ i} Mail�f Subdivisl n
Authorized ,agent _ . - i i ��. __._- , ZIP-
O Cw w TA DES D PTS Phone # t�"� /Rive Basin I
Affected D OEA ON P IH C USA 0 NIA
AEC(s): r��, Adj. Wtr. Body rrtat._I ar unkn,
ORW: yes/ PNA es' no Closest Maj. W ody._✓
Beach Bulid
Other -.._
Shoreline Langth _
SAY: not sure yes to '
Moptorlum: rda yes no
Photos: yes n
Waiver Attached: & no
A building permit may be required by:
(Note -Local Pianningfurisdictlon) tti
Ag a t rlih ei ai
r
Sigiuture '�*�{p',�a�rcadesr
,to a kof ermit**
Ch &
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.
f —
See note �h track reQ4rdlo.01yer Basin rules.
SI na
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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, 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 how to 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 APPLI AC TION_
Name of Property Owner Requesting Permit:
Mailing Address: FJ e_oLAk �! -
'� %VCR
Phone Number: r� 5 ' 3 q ' Dd
Email Address:
I certify that I have authorized L co
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
i'r �- LS �
at my property located at iq 6 B e-O W-\ W �4 ly( 5 7cv
in�_ County.
l 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:
1'
A
Sig6ature
Print or Type Name
Title
Date
This certification is valid througha��

ADJACENT RIRI AN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C—s
arty
(Na e f Pr pno r) - 7v
property located at Cl 6 �� (�� l
on &oQSc' �` ��L�L (Address, Lot, Block, CA S d, Uc N.C.
(Waterbody) (Clty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
U Jqpdfion,
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
&-le A-41nlCtxe P S�-10-�—
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
m If you wish to waive the setback, you must initial the appropriate blank below.)
V.
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
4
(Pro/%perty Owner Information)
Sntre iGY/ 7&--S
Print or Type Name
Madinq Address C .
Cir / tate2l
2 qj Doa-
Telephone Number / email address
Date
Property Owner Information)
Signature*
"Cc U M` I S
Pr' t or Type ame
Tn'c 'PA
Mailinq Addr ss .--
City/State0p
Telephone Number / email address
Date*
'Valid for one calendar year after signature"
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMEN
I hereby certify that I own property adjacent to 1 C`�t t 's
N e of Pr rty er)rc
property located at (Q' ` f�
(Address, Lot, Block Road, etc.)
on CTtSe CC^� 8�� , in PtC«-�- , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to 'on.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
6e-e op'&'Cc�
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, 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 must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner) nformation)
Si nature
_ ll�I,`LCS JACOBI
Print or Type Name
4 A
Mails Ad%ss
Cit /State/zi G a
Telephone Number/email address
1-----
Date
(Adjacent Property Owner Information)
Sig &U erbov pow 2
Print or Type me
Maili CA} ess_� A, C �( j?
City/StatelZip L
Telephone Number / email address
Date*
'Valid for one calendar year after signature*
(Revised Aug. 2014)

Property Owner: Charles Jacobi
Property Address: 196 Beulah Lane, Newport, NC 28570
Drawing Prepared by: Cody Scott/C3 Scott, Inc.
Date Prepared: 12/15/2020
Scale: 1 "= 30'
Goose Creek
New Work:
Proposed new 4 Pole Boat lift
locations
North
BJ Taylor Rd

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1/26/2021 Image (252).jpg
CAMA/ODREDGE& FILL
GENERAL PERMIT
New Modificatlon Complete Reissue Partial Reissue
As autholized by the State of North Carolina, Depáftment of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC
NO 7828 A
Previous permit #_
Date previous permit issued OH
hecksuok. Project Location: County CZyu
Street Address/ Stpte Road Loty#()L Address_
CRy 1UTEMa Ciy eiA
Phone# NUTMai
Authorized Agent
Subdivisian
Affected CW
AEC(s)
w
OOEA OHHF IH
eTA HDRv BanhlyA DES OPTS
OUBA ONA
O PWS Ad. Wtr. Body, (nat an /unkn)
ORW: yes / ho Closest Maj Wtr Body AUI Y PNA no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s).
Floating Platform()
Finger pier()
Groin length
number:
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channe
cubic yards
Boat ramp
Beach Bulldozing
Dther
Shoreline Length .
SAV: not Sure es
Moratorium: na yes no
Photos: yes n
Waiver Attached: (Ve
A building permit may be required by:
(NoteLocal Planning Jurisdiction)
Notes/Special Copditions
See note gh back regarding, River Basin rules.
Agept or AnpHtant printed Nay Permit Offirerinted Name
X
Signature *eas readeeraparice statement on baqkofpermit** Signat/re 00a Aolicdelon feels) Issuihg Ddté Ekghiraplon Darë
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