79424A_Staley, Richard_20210920

(W- ✓
❑ CAMA / ❑ DREDGE & FILL O
,. N . 79424 'JA B c D
GENERAL PERMIT Previous permit #
❑New ❑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 SA NCAC
O Rules attached.
Applicant Name - A ' Project Location: County
Address f<�-e \1 C Uf Street Address/ State Road/ Lot #(s)
CityState W ZIP t: t
Phone # '�3` kt� E-Mail Subdivision
Authorized Agent • ct.t , 1,�� ,tiE, AC' City ZIP
Affected ❑ Cw ❑ EW D9 PTA ❑ ES M PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA Adj. Wtr. Body (nat /man /unkn)
❑ PWS: v,
ORW: yes / no PNA yes / nd Closest Maj. Wtr. Body yy i { K ivf'V
71
NONNI
was
11M No
amomomms
10, IMMUNE
W21101p,211ME
nil
MMM!!!!
MR
PENIS
!MPH
MEN MFAUMML�4plmm
ME
i
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s)
Signature
'/C0/1.( I/ZO/-tZ
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 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 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/ 1-888ARCOAST 252-946-6481
Fax: [phone] 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)
(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

Name of Property Owner Reques" Perrnit
I cwW that 1 have authortwd
L.-agdee7 - t77CIr; lle
--T A9W I C
to act on my behalf, %r the purpose of applying for and obtaining all CAMA permits
necessary fir. the Mowing proposed developmem&,X 35 i el
I LI r I (D' Pl a ,� c.1 xab S�PP��n 3 j< 3� ' cut""al k
at my ply loc ab3d at `-{ -5
in T� County.
I fur#wmore certify that I am authorized to grant; and do in fact grant permission to
Division of Coastal IKanagaement staff, the Local Permit Officer and then agents to enter
on the akwemenboned lands in connection wifh evaluafing information nested to this
permit app.
ichavd 344
Print or Type Name
?ro per+Y Ow✓1 e+--
This cx"fication is "M tnrougn

l herd cry tgd i own property t ID
property located at�Sn
RONA u)
on � � w . N_C_
(MYakboxdy) (dawn a&94 County)
The applicant has described to me, as shown below, the development proposed at the above
iocafion_
_ l have no ob CUM fo ffft FgXWal.
! have objedwns to this proposal.
' ION ANDIOR ORAIiM OF PROPOSED ©EVEIAPNIEW _
Pf
14-
c d 3 w x sc� L- CaI44
VINYL 601*10KAD
sEcnoN
i understand ftwd a pier, dock, mooring pilings, boat rarnp, breakwater, boathxm-,- fit or groin
must be set bade a rrrsanum die of 19 tun my area of riparian mess unless waiaed by
me. (If you wish to waive the sebadc, you must initial the appropriate bku* bebw_)
l do wish to waive the 19 suck requeernent
t do not wish to waWSOM 19 wdAck mq* ernent
t Petit 4 Win?
Ra>t ? T PMW or type Name
i5h br . q S 3 PQ VI STA d A
r' �G xt .2 t" ,a 6 T,'`l. �, 27? a9 ys3
3l(r �S�-33• -.214 2ANLA Ie4jf
t address t Mumbsrlem� addkw
�// Spa ,oz/
Date Duke*

ADJACENT RIPARIAN PROPEM OWNER GTAT lff
I hereby certify tify that I own property adj mt IQ JZ & w 's
property located at LIS Cos^ �/` i�5rf G.�
on L,,-,LVA in , — . P
(Wal arbody) tCri Town akfarCow
The applicant has described to me, as shown below. the moment proposed at the above
location_
I have no objection th this prgwsal.
I have objections to this proposal.
ONION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
. - --- �.. _ . _.._ _-
og dev�elopme>ti must fib in iw or attach a sf j _A4.
; 0"
I U Co rs4"`--NW114 I&,/— F
,
G �- 5�i e dam. I ���o/'.-►-t �d 3 w .r 3� L- L ufwW,
WAMM SEC-1XM
I understand tW a pies, dock. mom % pNr+gs, boat ramp, bredwsWer. boathouse;- It or Wm
must be set back a adrdmmndial P i g of 15' from rrry area of riparian access unim waived by
nta-(f you wish to waive the sedxw k. You must IrdW the appropriate black below_)
I do wish to waive the 19 seffiac3c requi emerft-
1 do not wish to waive the IT selimc k re*+ement.
(Property Owner lrtormation),,- (Aommt Property Owner Information) 16- 7,4 «fZh 51
L%A=
CNC;jIda
�3i�
T�ejohov�e Mnnbw/ ad�ss
�—/'3—Z02-1
ar Type Mame
I '3 wig"Oo©v /�7 ✓d ��
77 << V� z z0/.)
`4 �, .3 .. Yy6 2-L» -
Telephome Number/emei address
Ei3- Z-0y

M o � Su c_ L, ✓�

0�1
a
/o V v) 6)
Af ,adofc
� Yo t/Ut5,11 ' y
aa�v�

a
1
•, A
,L
Lit

March 29, 2021
fvY OL r \rti. 54- a
2'1�10CA
Paoli intnnk C�ni inty N('. W55 V' ', D{'
1:1,128
0 0.01 0.02 0.04 mi
0 0.02 0.04 0.07 km
NC CGA OwEye, Maxor, MlcrowN

o?�
����
.�
.ran �1

le Earth
200 ft
AML.
'FA'w
N