Flora, Mike 78285C

�YCAMA / El! DREDGE & FILL
.
9 79?85 A
B � D
ENERAL PERMIT
i
Previous permit #
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date 1plfvious perm' issued
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 SA NCAC
ules tached.
Applicant Name
Project Location: County 4
Addre
Street Address/ t e Road/ Lot #(s)
Citoi�
y_
State ZIP
-----�"�� - 'ItZ11(l,
Phone # (}
E-Mail
Subdiv' io
Authorized Agent � � I
City_
ZIP
r
1 ` W T❑ Ew TA ❑ ES ❑ PTS
Phone # iver Basin
Affected
AEC(s): ElOEA ElHHF Ll 11H ElUBA ❑ N/A
Adj. Wtr. B
(nat / n nkn
❑ PWS:
ORW: yes / o PNA yes / o
Closest Maj. Wtr. Bod
Type of,Project/ Activity
Pier (dock) length
Fixed Platform(s) - -
Floating Platform(6 —^—
Finger pier(s)y
........... ;—
Groin length.----,
number __._.............. ....._
Bulkhead/ Riprap length—
avg distance offshore`'
max distance offshorel*_�
Basin, channel
cubic yards f— �y►✓
Boat ramp
Boathous Bo lif /\f
Beach Bulldozing —
Other
V__ r
Shoreline Length 1
SAV: not sure yes Un:
Moratorium: n/a yes
t
Photos: bye
Waiver Attached: no —
A building permit may be required by:
( Note Local Planning Jurisdiction) p
Notes/ SpeXial ConcUtions
or Applicant
ame
❑ See note on back regarding River Basin rules.
A / ,_ .a
Name
Si �naturree please read compliance staterneripon back of permit
Application Fee(s) Check #

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 ❑ 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 - (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

AGENT AUTHORIZATION. FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Y-n; ltg
Mailing Address:
Phone Number:
Email Address:
r G/) . '/ L� ^ � / l
I certify that I have authorized rn v� 1r) L-,--\Qi I>- le-cl-) ;7- t-" C-
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:
at my property located at
in CA
County.
5 yL:—:7
1 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:
' IOC)
100
Signature
I Z=z
Print or Type Name
Title
2 1 9� 1 RECEIVED
Date
JAN 0 4 2021
This certification is valid through / 1 DCM-MHD CITY

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ion below or Mach a site prewar yj
(Individual proposing development must till in
L 4-
WAIVER
I understand that a pier, dock, mooring pilings, b
back a minimum distance of 15' from my area c
wish t w e the setback, you must initial the a
f I do wish to waive the 15' setback n
i f '
I do not wish to waive the 15' setbe,
(Property Owner Information)
,Si afore
F2b`gt or T,u�ne Name
"l /�-`�< 2-1
AWing Address
City/State/Op r
��CJG
Telephone Number
Date
EOTIOI -
eakwater, boathouse, lift, or groin must be set
h, riparian access unless waived by Me- (If you
ipropriate blank below.)
uirement.
requirement.
(Adjacent Property
mer Information)
Print or Type'Name
Mailing Address
City/State17ip Z
e;ephon Number
N_ 7 /� -
Date
(Revised 6/18/2012)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i"` + u.r V totA 's
Z (Name of Property Owner)
property located at 3 ���>✓., r?�^
(Address, L lock, Road, e )
on �.4�++-+� 1 1... �►-.�4c. T�QEgC,6 , N.C.
(Waterbody) (CitylTown 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
o
WUJ
v
_ WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 Inf rmation)
'Signature e
Priot or Type Name Print or The Name
Maili g Address,, ,yy Mailin Address
�'' � jC. f ✓' !c 'y ,-=i / � ..� � 7�r' �---- 0 C-l� O.,r n � il% o� 0.3
City/State/Lip : , City/State ip
fL_- j/ y ! S�� 3912
Telephone Number Telephone Num or
Date Date
(Revised 611812012)

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I hereby certify that I own property adjacent to k iC,r
(Name of Property Owner)
property located at ��� �>�1�-ogv ✓� ''l7�_
(Address, L t, Block, Road, etc
on L 4 "-A 1 , in As'c a 4-i 1 1✓ .i9 CJN.C. .
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown bE low, the development proposed at the above
location.
" I have no objection to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in Idescripdon below or attach a site drawing)
e I Ex�s♦�N�
10444 r
I understand that a pier, .dock, mooring pilings,
back a minimum distance of 15' from my area
wish to waive the setback, you must initial the
I do wish to waive the 15 setback
1 do not wish to waive the 15'
(Property Owner information)
�Siir—ature
P-ri9t or Type Name
Mailing Address ,
City/Stategip
Telephone Number
Date ,
;akwater, boathouse, lift, or groin must be set
riparian access unless waived by me- (if you
)ropdate blank below.)
uirement.
requirement.
(Adjacent Property Owner Information)
Print or Typ Name
S.(-
Mailing Address
City/State/Zip
Telep�ho�nJ Number
Date
(Revised 6118/2012)

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