76951A_Jayne, Jeffery_20210717

),CAMA / - DREDGE & FILL 7L �—
GENERAL PERMIT Previous lit# B C D
]New —'Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality lip
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC � ���
® Rules attached.
Applicant Name �Q�n,� �� •. ne.
Address I a I(. S.'"J ShBte 6c
City Att\ ot\ State_ CC ZIP a1`�32
Phone # ( ) E-Mail
Authorized Agent 5� e- l ucL r- � 3)Q \re,2tp
Affected ❑ Cw NEW ® PTA 5C ES ® PTS
AEC(s): ❑ OEA ElHHF ❑ IH ❑ UBA ElN/A
❑ PWS:
ORW: yes / 0 PNA yes / Q
5kewar)r ibO_V1P_& �>
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
'sLlOy oG IdOa
Application Fee(s) Check #
Project Location: County_ Ckawa.Yn
Street Address/ State Road/ Lot #(s)
� 1 (p �run�ii Shtre.
Subdivision au ad ee S
City ecien--cn ZIP 77 q3 it
Phone # () River Basin PaLs��s��
Adj. Wtr. Body__. r�� �C so, J Caaj/man /unkn)
Closest Maj. Wtr. Body -- 0 4V-4 ale le 5a,rJ
AA
Permit is Printed N e
Signat
711-7/90 /�-7 ia0
Issuing Date Expiration Date

Statement of Compliance and Cori
This permit is subject to compliance
violation of these terms may subject t
null and void.
This permit must be on the project sitE'.
applicant certifies by signing this perm
confer with appropriate local authorii
ordinances, and 2) a written statem
landowner(s) .
The State of North Carolina and thi:
information and belief, certify that this
River Basin Rules Applicable To Yot
Tar - Pamlico River Basir
:ency
i this application, site drawing and attached general and specific conditions. Any
)ermittee to a fine or criminal or civil action; and may cause the permit to become
I accessible to the permit officer when the project is inspected for compliance. The
at I) prior to undertaking any activities authorized by this permit, the applicant will
to confirm that this project is consistent with the local land use plan and all local
or certified mail return receipt has been obtained from the adjacent riparian
vision of Coastal Management, in issuing this permit under the best available
sect is consistent with the North Carolina Coastal Management Program.
'roject:
fer Rules Other:
Neuse River Basin Buffet les
If indicated on front of permit, your pr
River Basin checked above due to its 1(
Water Resources. Contact the Divis
Wilmington Regional Office (910-796-
Division of Coastal Management (.
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-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)
:t is subject to the Environmental Management Commission's Buffer Rules for the
ion within that River Basin. These buffer rules are enforced by the NC Division of
of Water Resources at the Washington Regional Office (252-946-6481) or the
5) for more information on how to comply with these buffer rules.
:es
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

5MD( if"(:!- 1 I&-, M5A)- C-o-tl_
Authorized Agent Consent Agreement
1 Jeffrey Jayne , hereby authorize Stewart M Davenport to act on
(Property Owner)
(Authorized Agent)
my behalf in obtaining CAMA permits for the location listed below. This agency authorization
is limited to the specific activities described above.
Property Address:
Jeffrey Jayne
1216 Sound Shore Drive
Edenton, NC 27932
Property Owner's Mailing Address:
Jeff rev Javne
1216 Sound Shore Drive
Edenton, NC 27932
Property Owner's Signature:
Authorized Agent Signature:
Date: V,01 /2,m%,p
Form: Authorized Agent Agreement as developed by NCDCM revised 9/25/06

GERI 11-ILRI ITIAIL,,., ?NtL;tlF'l
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(Domestic Mail Only; No Insurance Coverage Provided)
For delivery information visit our website at www.usps.com
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Postage
$SS
3 Certified Fee
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3 Return Redept Fee
(Endorsement Required)
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7 Restricted Delivery Fee
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(Endorsement Required)
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Total Postage & Fees
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or PO Box No.

Certified Mail Provides: ■ A mailing receipt (esenea)ZOOZsurr ppg£wjojS�
■ A unique identifier for your mailpiece
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■ Certified Mail is not available for any class of international mail.
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valuables, please consider Insured or Registered Mail.
■ For an additional fee, a Return Receipt may be requested to provide proof o
delivery. To obtain Return Receipt service, please complete and attach a Returr
Receipt (PS Form 3811) to the article and add applicable postage to cover thi
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver to
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required.
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IMPORTANT: Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.

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Postage
$ 5
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Certified Fee
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Restricted Delivery Fee
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(Endorsement Required)
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Total Postage & Fees
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� Stieef. Ani Nri
or PO Box No.
-------------------------------------------
City, State, ZIP+4

Certified Mail Provides: ■ A mailing receipt (as-aao aooz Bunr'ooee W,o� sa
■ A unique identifier for your mailpiece
■ A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may ONLY be combined with First -Class Mail© or Priority Mail®,
■ Certified Mail is not available for any class of international mail.
■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
■ For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPSo postmark on your Certified Mail receipt is
required.
■ For an additional fee, delivery may be restricted to the addressee or
idressee's authorized agent. Advise the clerk or mark the mailpiece with the
Ament "Restricted Delivery".
■ „ ^ the Certified Mail receipt is desired, please present the arti-
cle at - for postmarking. If a postmark on the Certified Mail
receipt is ho... -h and affix label with postage and mail.
IMPORTANT: Save tftta —asent it when making an inquiry.
Internet access to delivery it.— ^nt available on mail
addressed to APOs and FPOs.

0 Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
Print your name and address on the reverse
so that we can return the card to you.
0 Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
t a ► � Souk s ►�ne��r�tix
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❑Agent
❑ Address
B. ei d by (Printed e)
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D. Is delivery address differ from i ern 1 .
Yes
If Y enter delivery address low:
❑ No
3. Service Type
Certified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandisc
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
?. Article Number 7003 0500 0000 8817 2577
(Transfer from service label)
]C C—,— 11Q1 1 r: FK inn. onne r)--tir Return Pint

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UNITED STATES ICE First -Class Mail
►'+r Postage & Fees Paid
d ) X)L 1e 7'J1 USPS
111111 Permit No. G-10
Fender: Please print your name, address, and ZIP+4 in this box •
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■ Gomplet'e items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Alan �Y Cdc. cl
(a 14 5ou `JHv��r1`V�
A. Sig
Cr Agent
X / ❑ Addressee
B_.Ubiv by (P/inted e) C. Dgte of Delivery
D. Is delivery address dff@AVrom iterZ1? 97 Yes
""T enter delivery address below:
❑ No
7
3. Service Type
)KI Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7003 0500 0000 8817 2584
(Transfer from service label) _
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATE94k* AI I VICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
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