Tyler, Tim 84108C

❑CAMA ❑ DREDGE & FILL N9 84108 A B C D
3� Previous permit
. GENERAL PERMIT Date previous permit issued
New []Modification []Complete Reissue ❑ Partial Reissue
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:
15A NCAC C7 r ) ❑ Rules attached. L'J General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
TApplicant Name �
r y \
Address !%—,
City - -()� 0S�\4�y
tate k.— ZIP .S
Phone#(
Email g
Affected'! j ❑ EW ❑ PTA �. ES ❑ PTS
AEC(s): -`❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/np� PNA: yes/no
, A
Type of Project/ Activity 4
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s) /
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/N
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
i
Other Gin.
i
SAV observed: yes no
Moratorium: n/a yes no I
Site Photos: yes no i
Riparian Waiver Attached: yes no
A building permit/zoning permit may be re
Permit Conditions S '
� c ;
IAM
or Applicant PRINTED Name
by:
Authorized Agent�(i!
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City � � ^1 � �O V-/ F ZIP
Adj. Wtr. Body
Closest Maj. Wtr. Body
AND
Permit
'❑TAR/PAM/NEUSE/BUFFER(circle one)
r' LLJ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial) r /
Signature "Please read compliance statement on back of permit"
Application Feels) Check q/Money Order
Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Manaeement Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Berne, Camden, Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Fender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AdEMr4 C]CAMA ❑ DREDGE & FILL N9 84108 A B C D
GENERAL PERMIT D tepre io slpermitissued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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 ❑Rules attached. General Permit Rules available at the following link: wwwdegncgov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Email Subdivision
1
City I V. „ h.. ( ZIP
Affected j 1=-J 4W ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtc Body (nat/man/unk)
AEC(s): - ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no.
Type of Project/ Activity
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Boat ramp
Beach:.N.:::�■1:::.
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MEN
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A building permit/zoning permit may be required by:
Permit Conditions
i
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on
Feels)
permit" I ! . Signature
Check#/Money Order Issuing Date
Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 17 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
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 — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Nance of property owner AppWt'9 for Permit:
Maiftg Address:
f cerafy that 1 have authortaed (agent) _ate !, I" l/b# /hMW to actor my
be" for the pulp*" of applyb g for nod obtaWa aM CA" Perrtib mar' to
instill or Construct (activity)
at (nay property' boated at)
This certitkation is valld thi
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AIJJAMNT RIPARNIN PIR-0-p9 ,Q
I hereby oertify that I owl' PloPeity ad1006111 to ._LOIA-1f`
cL`d
p,operty,000 ed at _r J1 1 f) A a"ro", L a, filimk R 3�
on - (Woodwdy) (Gown er►�ywc Carrr� N.C.
1 he alytkcant has dosatbed to no, 06 shown below, Ilie dovebprrsM pOPOsed M In
above
kxat►on I have no obiection to this proposal.
I have ubtecbons to this proposal.
DESCRIPTION AND/OR ORAWINO OF PROPOSED DEVELOPMENT
y�tuw/ prgl►orJnp devyloprrmeirrt must ON M ds w*ftn 6Now or attsoh a s" dnwbrm
t"36r
WAIVER SECTION Ift or groin must be set
i understand that a pier, dock, mooring pilings, breakwataf, t unless ivad by me. (It you wish
back a minimum distance of 15' from my area of riparian aooes+
to waive the setback, you must inidsl the appropria1e blank below.)
t du wish to waive the 15' setback N**wno l
2 f % 1 I do not with 10 waive the IV edbKK ra
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(/t AWd 01910 $►
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