79358A_Moore, III, Walter J._20211013

`'CAMA / -1 DREDGE & FILL N9 79358 A, B C D
-. NERAL PERMIT Previous permit#
4119!w ❑Modification DComplete 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
❑ Rules attached.
Applicant Name r t Project Location: County U f f uL
Address j �c2 t Street Address/ State Road/ Lot #(s) �.
City jL,D ( L State ZIP
Phone # (7�2) E-Mail Subdivision
Authorized Agent I
Affected ❑ CW ❑ Ew PTA ❑ ES ❑ PTS
AEC(s): ElOEA ❑ HHF ElIH ElUBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
City
ZIP ?1
Phone # ( ) River Basin
Adj. Wtr. Body I 1. fk`' ?�/, f rc nat man un
Closest Maj. Wtr. Body "J
Type of Project/ Activity r `9 k• : CSC' t 1
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
cubic yards
Boat ramp
s �
j'goathouse Boatlift�
Beach Bulldozing
Other
Shoreline Length t IC.C_1
SAV: not sure yes �n
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: I i (k- c y-
( Note Local Planning Jurisdiction) ,�r
Notes/ Special Conditions !its - ;.- tr fr C far f L
Agent br Appli nt Printed Na
Signature * lease read coWipliance statement on back of permit
Application Fee(s) Check #
(Scale:
❑ See note on back regarding River Basin rules.
f-
<� I ci �
ff
Pe kofficer's Printed Name
Signature
1p-,3 -
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 (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/ 1-888-4RCOAST 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 Requesting POrtriit; Wa !_ L) 1y1 ier!
Wiling Addrel§: &I t. )o z"r,.l..4 U t.:)1
Phan@ Number.
Small Address: ,wt,'
10ortffy that 1 have authorized
Agent / Contracts , --
W 00 On my behalf, for the puFPose of applying for and obtaining all LAMA permits
nqmmr.y for the fQ119wing Proposed development, 5i�( I 1 �►�t
of my property Wooled at
County.
J fut#rermare W ify that I em authorized to giant, and do in fact grant permission to
DiVision of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned Jane's in oonnectfon wiilt eValueting information related to this
permit application.
Property Owner information,
�� 9r type iVtlrt�
This Wtoftatm. is valid through 44 r J1 J_. - OZ--

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 3 6-ew /YfO0✓c 's
Name of Properly Owner)
property located at 0 t �/ho►t
(Address, Lot, Block, Rod, etc.)
on )CV10411 r`114-1.c( in /6'-o (4 N.C.
(Waterbody) (CityrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca tc'
f 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)
(A 0 � � 1 p7-44G Z y
cjaleNl a►� y • 1 VVl'°o are
C�
E j.�(�✓ S `W 1 WAIVER SECTION I `
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.
(Pro erty Owner Information) (Adjacent Property Owner Information)
-
Si afore
1 4a o5 C .Lha,V rux.mew
Print or Type Name ()f Print or Type Name
Mar g Add ss Mai ing Address
Ala; A UYS /UC ` l yd S
CiCifT/Stwe/Zip Cit 113 te/Zi
z 6� - �3q o ®O
Telephone Number/email address Telephone Number/email address
6��Gk 14 2-JZ( 3` \`l t1.14
Date r % t/ Date
�3 e4Gy �Qv`�S � �Ki " Caf/lj (Revised Aug. 2014)
'Valid for one calendar year after signature'

718 P 41 —4N t
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