80197D - Hussey

0 CAMA / _ DREDGE & FILL ______. No 80197
GENERAL PERMIT Previous permit# A B C
>� DNew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit 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 5A NCAC �/y 1til0
CI Rules attached.
Applicant Name /7e/7/7ie paa5 Project Location: County '1•?Ic,'t lc
bile I'Address 4 35 /� �i; iI\e' Street Address/State Road/Lot#(s)
City eri len State NC ZIP 7 "a ry,
Phone# ( ) E-Mail Subdivision ,/
Authorized Agent � �; IfrltC s ( . ,{�City / /s(a,-,C..' ZIP YRr' /2 gq6 S
Affected ❑CW ❑EW ❑PTA DOTS Phone# ( ) RiverBasin GGW —I b"
AEC(s): ❑OEA HHF ❑IH ❑UBA El Adj.Wtr. Body 7)/( ( IS ('al./2 (hat ®/unkn)
❑ PWS: M
Closest Maj.Wtr. Body /"17"zrwG S(d7�f_ fii
ORW: yes / no PNA yes / 0 J
Type of Pro' ct/ 'Activity . _ 41/)' 2 /1/51-et r p ✓� moeho I
-!?f '�d yr�Or'1c/s
(Scale: /'i ?() )
Pier(dock)length
iFixed Platform(s)
Floating Platform(s) - j
Finger pier(s)
j 4 I - _ —
7 — —
Groin length
number i • ..._. 1_.. �
Bulkhead/Riprap length be k //
avg distance offshorei 3
max distance offshore 0 ;PC V t' !g /Uq0 4 li�yI o l
Basin,channel 1 `r /T 7 !� 1 i 7e. "p •
j l /ttl. 7 1Lk2� alr .I
cubic yards —._` f I I ' (/[k- re) �-i ,
I i
I
Boat ramp 1 1 i
Boathouse/Boatlift -------- —1 }._.-... - IG''
Beach Bulldozing `---- —i i
;
Other ( ; ry!'
__. '4V 4?-1
,.____ d c L
l,'*' 5 r----- i
Shoreline Length 6 0 i - i �„b/ I -. 4 j
SAV: not sure yes i
Moratorium: n/a yes rr sSCt/ j itit, -4'3-La .OI 64... ...
Photos: yes 6, 1 t •— —� I
Waiver Attached: yes ® '
A building permit may be required by: 19-14.1/1 gal f!- '4/ • ❑See note on back regarding River Basin rules.
(Note Local Planning jurisdiction) - /J /'
Notes/Special Conditions / t f zr' 7//,//Cr. //ef-/,- .1( J�j' i�(/G!'d-i
1m `ir'`ii P fi-e 7ffn.(a
Agent Or Applicat Printed Nam Permit0 r' Prin ame
Gt'
Signature Please re compliance statement on back of permit** Signature
NGG IG63$ Jw�.1/ //'/-?.?
Application Fee(s) Check# Issuing Date Expiration 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 I)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(9 I 0-796-72 1 5)for more information on how to comply with 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/ I-888-4RCOAST 252-946-648 I
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 Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Ravica(I 7/0A/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: £2,4,7/ _ /Yusso
Mailing Address: C,` £rvY 4k ` r'
.4/e-
Phone Number: 3 36 -553 - 307 s3
Email Address: �j'
! certify that I have authorized �/�� i��`0"4- �/71
Agent/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1 / iiy
Pifi
at my property located at 1 c7 L1 (5g DEG �'1v
in 6 iwr, ).)1 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 Inform tion:
• natur
d /7
Print or T p Na
Title
ate
This certification is valid through A. 13r) / c2- 1

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•'
• CERTIFIED MAIL • RETURN RECEIPT NEQUESTED •
DIVISION OF COASTAL MANIGhMENT
ADJACENT RIPARIAN PROPERTY OWNER P OTIFICATION/WAIVER FORM
Name of Property Owner:
_ CaY1 nifi IILI5$ L_
Address of Property: 102 y c,V .___r o 1:54.1
(Lot or Street#, S.reet or Road, Cry County)
Agent's Name #: ✓i� "/Sk..,- _ Mailing Address: '9'a- t7 �
Agent's phone #: �(J- 03)a S
I hereby certify that 1 own property adjacent to the above re-irenced property. The individual
applying for this permit has described to me as shown or tha Grtached drawing the development
they are proposing. A description or drawing. with dirnsuion.roust be provided with this letter.
/I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notiry tr.e Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp://www.ncc)astalmana_gernent.net/web,'cm/;taf!-li:-j or by calling 1-888-4RCOAST.
No response is considered the same as no objection ifyou have -een notified by Certified Mail.
WAIVER SECT1OU
I understand that a pier, deck, mooring pilings, boat ramp, breaawater, boathouse, or lift must -
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If . t
you wish to waive the setback, you must initial the apprupr ate blank below.) � ' t
I do wish to waive the 15' setback requireme lt.
I do not wish to waive the 15' setback requirement.
(Pr rty Own Information) (Rip:rain tyro t = r: •wner Information)
41411
Si nature Si, ure.
aril& SA J HI4RR 1LC-
Print or Type N me Print or T.ypa Name
es.) rd
Mailing Address Mailing AJdr9ss
l 4/(i Z)7 0.39
City te/Zip Ci�y/:tat fL
33/,— CS a _--PO • cD. a
Telephone Number/Email -ddress Telep home i. amber/Email Address
01/1,3) 0)'21 AZ1
Date Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT J;EQUESTED
DIVISION OF COASTAL MANAOPMENT
ADJACENT RIPARIAN PROPERTY OWNER hOTlF CATIONIWAIVER FORM
Name of Property Owner: _ d/74 j C /IqS5 es
Address of Property: _ )a cJC e Oak S f nil , /1a'
a
(Lot or Street#, Street or Road, C ty County)
Agent's Name #: Me/ file _ Mailing Address: q. /Y d c(—
Agent's phone#: ?)/) i3o - as3o .—_thvs,14 /1k agy3
I hereby certify that I own property adj E if to the above re+renced property. The individual
applying for this permit has described to me as shown or. the a:rached drawing the development
they are proposing. A description or drawing. with dirnan:,inns must be provided with this letter.
J I have no objections to this pr�posa . I have: objections to this proposal.
If you have objections to what is being proposed,you must notify t:.a Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Ccmt`.ct information for DCM offices is
available athttp://www.nccoastalmanagement.netlweb!cm/ataf!ditinq or by calling 1-888-4RCOAST.
No response is considered the same as no objEction it rou have:been notified by Certified Mail.
WAIVER SECT1Oill
I understand that a pier, dock, mooring pilings, boat ramp, breaKwater, boathouse, or lift must
be set back a minimum clistance of 15' from my area of hoarier, access unless waived by me. (If
you wish to waive the setback, you must initial the appruprate blank below.)
1 7
I do wish to waive the 15' setback requirement. 0 ;(C 0
/ I do not v'ish to waive the 15' setback requirement.
(Pr rty Owner I fo mation) (Riparian i.Iroperty O. er Inf tion)
Signature Signcaure
— AidIS d f cl1).
Print or ype Print or Type. Name
Mailing Address Maiiirg li:Ic ss
et1471‘ t 1.1.6___GRX;27 eirlf ( /0 0 76iy
City/State/zip r G4/52tat l2 `
3_336) - W- 3 ?S3 I7- co -/,2 73 Me ds-es5"�"1
Telephone Number/Fail `
Address Telephone i;amber/Email Address c`,'it
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'511_ai i a 1 ,..) 1
Date Dale
(Revised Aug. 2014)
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