Tyson, James 80483C

CAMA / ❑ DREDGE & FILL 9 80483 A B D
EN ERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous ermit issued
As aut orized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental pursuant to 15A NCAC—
I It
Rules att hed.
„ry
Applicant Name Project Location: County n�
Address, Street Address/ State Road/ Lo #(s)
City State IP
Phone # -Mail— — // Subdivision
/ . "i JV
Authorized Agent
Affected ❑ CW W ❑ P1
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:__
ORW: yes /en / PNA
Type of Project/ Activity 4
Pier (dock) length
Fixed Platform(s)
Floating Platfor (s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore -'--
max distance offshore
Basin, channel �— i
cubic yards _—,
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other e
Shoreline Length Loo ( I
SAV: not sure `yes
yes /
Moratorium: n/a yes no
Photos: s
.............:....
Waiver Attached: no
A building permit may be required by:
( Note Local Planning jurisdiction A
Notes/ Special Conditions
A
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■ UBA ■ Adj. Wtr. Body
Closest Maj. Wtr. Bod
Permit
,1 1 )
(Scale: j,
❑ See note on back regarding River Basin rules.
Signature9
��C read compliance statement on back of permit" Signature
11
Application Fee(s) Ch ck#Y Issuing Date Exp tiara on 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 (252-946-648 I) 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/ I-888-4RCOAST
252-946-6481
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
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)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
410-796-7215
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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:ow Iva,
Email Address:
-�_—
I certify that I have authorizedr
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Carl-Fl6k3
at my property located at j 3tLN
in County.
1 furthermore certify that 1 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.
Owner Information:
/ Sryature
Print or Type e
Ocouel-?'
Title
l�l / RECEIVED
Date
APR 2 9 2021
This certification is valid through / 1
DCM-MHD CITY

I hereby certify that I own property adjacent to .0
,.�eoPro ® Owner)
property located at _ (�Z
PpAon ~ ( j '`,e
(Waterbody)
(Address, Lot, Bloc Ro d, etc. e N.C.
in
(CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
oc do .
I have no objection to this proposal.
I have objections to this proposal.
� - u DESCRIPTION AND/Oil DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description Below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 wave the setback, you roust inKial the appropriate blank below.)
idows wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
,(Pro erty Own r-lfi rrrration) (Adjacent Property Owner Information) R
i r
t o .Type Na ( P 'nt,or y N. e7a z ve'
Mai ' Address./ / Maili�q ddres
ph�lczsi e ��e'czC��•
City/state`Li
Telephone Number elephon Number
Date Date RECEIVED
(Revised 6/1KO12)
APR 2 9 NZ1
DCM-MHD CITY

�,
y

I hereby certify that I own property adjacent to (Name of Property Owner)
property located at ( r U Z^a- ` f V �^
(Address, Lot, �" I «
% Rd )
_ �-i -� q�
- —rr ',�� in 'l' N.C.
on (Waterbody) (City/Town andlor County)
The appli ant has described to me, as shown below, the development proposed at the above
ocatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing develop�rrent must 11 in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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
Si
e-
City/Stat Lip
Telephone Number
�7,. o��
Date
(A!/ t' party Owner Information)
7
Print or ype Name _
Mai(. Address
(��iiCf�fo/7in 1
�" h eiN be
Date RECEIVED
(ReAvised
2)
R 2 9 2021
DCM-MHD CITY

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