Goose Creek Landing HOA 78284C

❑ CAMA / ❑ DREDGE & FILL 1V 9 7828 --F A B C D
GENERAL PERMIT Previous permit#
El New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commis ' n in an ea o environmen I concern puts ant to 15A NCAC
ules attach
Applicant Name Project Location: County
Address Street Addres to Road/ t #(s)
City State ZIP
Phone -Mail Subdivisio
e_ L
Authorized Agent City ZIP r� c
Affected ❑ CW EW PTA ❑ ES ❑ PTS Phone # River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body at /man /unkn
❑ PWS: � r
in
ORW: MYS no PNA Ces/ no Closest Maj. Wtr. B ^
. n
Shoreline Length
SAV: not sure yes no ......... ....... - -i — - —
j I - — -
Moratorium: n/a yes no !
1 r - �.
Photos: yes no i ...
Waiver Attached: noiardi _❑
A building permit may be required by:LA See not c�C r on b�egRiver Basin rules.
( Note Local Planning Jurisdiction)) q n D i A n) l A I /� ^— '^ � t ��/ �' A
Nn1•ac/ Cnarial CnnrlitinrM ' J ��/ /� �� A /h�/ [ ,l � W I � t
or
re e e read compliance statement on back f permit Si�1,sj
aure T
-/
r ,,,, L(O heck # Dat xpirat 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, 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 APPLICATION
Name of Property Owner Requesting Permit: �8c)oc, e, C,, re e nrl i rDOA - Lo u�
Mailing Address:��,
Phone Number: 25 2-
Email Address: C, 2 r C, (a7 a rr,c� i i � 00 ran
I certify that I have authorized J�A-��1� 1 �! �• ���1', O r a
'Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: demo I i -�-i On Ci nd
in Gc i r -% Q' e-�- County.
i 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:
Signature
e 0 ASS Glar
Print or Type Name
Title
- o
Date
This Certification is valid through

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to e G 10A,
'S
(Name of Property'Owner)
property located at 501 v i e.W
(Address, Lot, Block, Road, etc.)
on - —,in new r7oy-*- / G21- J:-Crfi" N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatpn.
I have no objection to phis proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or a4tach a site drawing)
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 Information) (Adjacent Property Owner Information)
or Type Name
Mailing Address
Telephone Number/email address
_ .
Date
'valid for one calendar year after signature*
Q Ira to bI, fts
3�i QYJntuvo *
Jznge la Burns
Print or Type Name
��350 Reddq Barn Road
7�ewpg,4f dresrsth Carolina 28570
ds-N�-/%6 or 252-393-2628
Tel pphgqne Number/email address
12%15/2020 18:31 Am PST
Date's
(Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Hereby certify that V own property aidjacent to © s
(Name of Property wrier)
property located at 501 Go, r,o, i Q n !2Q 0Lg-' vie'
(Address, Lot, Block, Road, etc.)
on _ in neyV4� fi .� Y `; G� 'i N.C.
Vaterbody) (City/Town and/or County)
The applicant has described to me as shown below, the development proposed at the above
location,
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development trrust tl,? in description below orafiach a site drawling)
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
fyyou
fwish 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 Information) (Adjacept Property turner information)
nt or Type Name
Stool c4nad iar\ aQ oze, .Ii evil
Mailing Address
City/Sta e/Ztp
Telephone Number/ email address
Valid for one calendar year after signature`
.Signature * c! 95C'yq �
PrintN
'
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Mallr� Add
C 6 ) rw(Ce�S`i' c �'a�l�i�folrtorvt
Telephone Numberf email ad Tess
.date*
(Revised Atug. 2014)

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11/19/2020 Carteret County GIS Website
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Middle School: BROAD CREEK MIDDLE
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Map Scale: 1 inch = 267 feet
Buffer
Long.-77.009 Lat 34.697
Long 0031 Lat 34°4148°
J f t t 1 _
77
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