Willis, Eddie 80582C

W
eAMA / ❑ DREDGE & FILL N9 8OS02 A B C D
NERAL PRRMIT Previous permit#
ISIev. ❑Modification Complete Reissue ❑Partial Reissue Date previous permit issued
>>' c
As au[h'b�ized by the State of North arolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name
Project Location: County
Address
City— - — —
Phone # (__)
Authorized Agent
Affected ocw ❑EW
AEC(s): oOEA ❑HHF
❑ PWS:
State ZIPr
E-Mail
OPTA'- 'tl ES ElPTS
❑IH ❑UBA ❑N/A
ORW: yes / no PNA yes / no
Type of Project/ Activity ,._.t!4f. ,-
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
Boat ramp
Boathouse/
Beach
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction) t
Notes/ Special Conditions i ' `
Agent or Applicant Printed Name
X
Signature rr Please read compliance statement on back of permit as
Application Fee(s) Check #
I
Street Address/ State Road/ Lot #(s)
Subdivision
it
City / i" ZIP— —
Phone# O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Mal. Wtr. Body --
(Scale: /t i - /7 j )
See note on back regarding River Basin rules.
r
PermitOfOcer's Pr meid Name r
i
Signature
Issuing Da E ration'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 th is 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/1-888-4RCOAST
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

AMA / ❑ DREDGE & FILL N9 78476 /�
A 8 f C'� D
L�iGENERAL PERMIT Previous permh# \��
M?IJew ❑Modification ❑Complete Reissue LIPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality % / - / /0U /-7 0
and the Coastal Resources Commission in an area of envir nmental concern pursuant to I SA NCAC ! rf C9 �'
/ 1 ❑Ru attached.
Applicant Name y-��,0 t " - �/ i Project Location: County�Y
Address U Street Addre(sss// State Road) Lot # )
City C36� �StateIV PF2,?,(-3 / J(J�� `` fry •-•ocf� l'�r/'
Phone #
Authorized Agent
fl cw —?VW .(fPTA ES 0 PTS
Affected AEC(s): OEA D HHF ❑ IH ❑ UBA El WA
PWS:
ORW: yes / no ) PNA yes/no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
ber I
Bulkhead/ "praplength 1[,.
avg distance offshore
distant oMMffstwre
Bain hannei
cublcyards. V
Boat ramo
Boathouse/ Boadift
Beach
Other
Shoreline Length
SAV: notsure
yes no
Moratorium: n/a
yes no
Photos:
yes no
Walver Attached:
yes no
WTfiiRf
City 17-cKfe `'',3-l�v— ZIP_
Phone# O River Basin W4
Adj. Wtr. Body. P / w �l � `j/Q 7 nat /man /unkn)
Closest Mai. Wtr. Body GCJG�i I _
`(ScaleG�� )
IN
■I!�
ME
t
��
►.
_.
AVA
A building permit may be required
( Note Local Planningjurisdictiol
ylotes/rSpecial Conditions S!
/V_l • ` rv�Vf J
tl
f `� lei We
Sig *' Please read compliance statement on back of permit"
c� / /43
❑ See note on back regarding River, Basin rules.
Name
2c3 (,/3U
Check # Issuinj Dater IExpiration Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Own
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: gyff— Y wo%5
Agent's phone #: (Q A-Ar1 I -.�P05
N�
. .. - .! �i" fry i. t.. •
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 �( 0
they are proposing. A description or drawing, with dimensions, must be provided with this letter.(,/
I have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp://www.nccoastaimanaoement.net/web/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been noted by Certified Mail.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.)
V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Alrscn T Willis
Print or Type Name
51a15 pay, Namam- fir.
Mailing Address
Nanv-ecy::� �,atud, Mr-
City/State/Zip Sitm)
Telephone Number/Email Address
Q-7WG_
Date
(Ripa " n-Paperty Owner Information)
Signature
Print or Type Namel
Mailing Address
City/statelzip
Telephone Number/ Email Address
Date
(Revised Aug. 2014)

I hereby certify that I own property adjacent to
property located at
on
I
Property Owner)
The applicant has described to me, as shown below, the development proposed at the above
locaflop.
(hRR. I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must BII in description below or attach 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 yoywish 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) �(A/djjacent Property Owner Information)
t•
3)
b-UUJ
Telephone Number/email dress
_rl Da:, 7 raw
Ddte*
(Revised Aug. 2014)
*Valid for one calendar year after signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to H It JT-) l • VV 111 I-'Z.> 's
property located at Cat(-. t'"1a& )P_ � 1(l(�VY��6 1�►t
�^ (Address, ot, Block, Road, etc.) t
on _ �,t,�j�- C�
(Water o ) (Cityrrown and/or County)
Theaplicant has described to me, as shown below, the development proposed at the above
k 16
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)
cm—)C�-
815 5� 5R� !n`oci�
\ /C?
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)
r�--, -:� wtL--)
Pnntor
Owner Information)
Mailin ddress
V-�,ew1j1
V, -AtG �Z 0
/St �Zia ,�(/o,G-''mil
Telephon N ber/email address
Date's I I
(Revised Aug. 2014)
'Valid for one calendar year after signature'

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: V-� Mt`J
Mailing Address: ��y�) cy L 1-lpmt�,k.. 1V2
Phone Number: (q g) q q 1' �q In
Email Address:
I certify that I have authorized Imu a T 7� �JC]� v ,
J Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: A )a� � I
at my property located at_('r��L
in County.1
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:
CO 0
Signature
_ �Ct�otrh� -7. WA V4b
Print or Type Name
Title
iQi�✓!
Date
This certification is valid through G 12)]_I90l

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