Monden, Phillip 80486C

CAMA / ❑ DREDGE & FILL
`;� 0486
A
B C
EN ERAL PERMIT
Previous permit #
ew ❑Modification ❑Complete Reissue
❑Partial Reissue
Date previous permit issued
As author
ed by the State of North Carolina, Department of Environmental Quality
e'-V' A00
and the Coastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC
ul attached.
Applicant Name
011 A11411
Project Location: County
r
Address q77 60
Street Address/ State Road/ Lot #(S-
City_ State ZIP%�C'/i
(f /�
_
Phone # -Mail
Subdivision n
Authorized Agent
CityWBody(a"
ZIP
`r Affected C CW f5(EW YIPTA ❑ ES ❑ PTS
777❑l
Phone #
Basin
AEC(s): El OEA HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr.
nat an /unkn❑
PWS- _
ORW: yes / PNA yes / Closest Maj. WtJr.
o
Type of Project/ Activity `
Pier (dock) length
n
Fixed Platform(s)
Floating Platform(s)
i
Finger pier(s) 4
Groin length__
number �--
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards --"--
Boat ramp
Boathouse/ Bo lift
Beach Bullciozinjz
Shoreline LMgth �tJ(
SAV: not sure yes
Moratorium: n/a yes o
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
N 4T/ Spe4ial Conditions
or
Signature . Ae read compliance statement on back of permit"
Fee(s)
(Scale: I
��
❑ See note on back regarding River Basin rules.
5
Permit
Signature V
�j ) -
Issuing Date Expiratio ate

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, certifythatthis project is consistentwith 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 complywith 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/ 1-888-411COAST 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1 {A IL-(-, U
Mailing Address:
Phone Number
Email Address:
I certify that 1 have authorized '
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: L)
fAat
my property located at
in County.
1 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 Information:
--- "f
Signature
Print or Type Name
Title
S / I-0 /-o>(
DatF;
This certification is valid through /
MAY 21 2021
DCM-MHD CITY

■
■4.05.2021 11:59 AM Russell Auto Parts 2527712930 PAGE. 1/ 1
■ May, 13, 2021 1:54FM Munden Funeral home 110. 101y r• i
T
r f✓/ v s
curt that I own property a scent to (Ne o of Property pwner
I hereby certify ,
property iocated at 6'
(Address, Lot, {oak, oad, to it �L N.C.
on In (Ct{ynown an or Coon )
(Waterbody) .
The appllcaant has dsecrlbod to me, as shown below, the Oevalopmont proposed at thm•abova
location,
I have no obJeotlon td this propoael.
I have objections to thi.8 proposal,
_.� pFBCkIPTI NAND/0 DRAVVING OIL PROPOSIgo DaVal opMEN
(IndIV/olual propwring deKatapmo t must 1Nl In dosor/pil+on below or attech ahe drr'wlrng)
et
I underat®nd that a pler, dook, moo Utg pilings, breakwater, P boet�Bolunleas waived i y Mgt (you
back a minimum distance of 16' fr m my area of m fan b enk below,)
wish to wQtva the setback, you mu Int O the app P
I do wish to waive the 5' setback requirement.
I do not w1611 to waive the 16, setback requirement,
(Property or Information) (A e"nt Prop* Owner I mta4lon)
Mat � �r
or pe me
r A� �
Prfnt ot" .
sl nD �4dd %qp
Maul ddt! � 7 k ,'0 a
atv�srate�zro _ ._ . «„ r�S'`
TalopHone um r �
,ate
nats Dare RECEIVED
(Ra 16od6AW12)
MAY 21 2021
DCM-MHrp CITY

4
4

AP3JAC NT I�I�ARIAN pCROpERT•Y OWNER STAT�I�i�d�ir
I hereby certify that I own property adjacent t Name o¢ Property owner)
property located at _������-�"�� _
n (Addressy L.ot, Uloct<, toad , etc.) G��f�N.C.
on Q�ul�^l T_ G r-):� in -f—h (� n and/or County)
pMaterbody) f�
The applicant has described to me, as shown below, the development proposed at the above
loc?ti n,
I have no objection to this proposal.
I have objections to this proposal. �m
DESCRIPTION AND/OR DRAWING OF PROPOSED OF_VEI°OPI1i ENT
(Individual proposing devplopmej t f1just till in de;:C�lpt���y I➢GIaW '�`" attach a site drawing)
O
or 0
41
WA lisp 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 ini'rial the appropriate blank below.)
do wish to waive the 15setback requirement.
Il do not wish to waive the 15' setback requirement.
Ad'aca�nt operriy Owner Infolynation)
(Property Ow er Information)(_�
Sa atu
_� I C rn 0 ri nt or pe Name
Print or Type a e
✓ / l l /, ---- Mailln Address i � ��� ��
Mail' g Ad ress _k
r�fo �;n
CitylStatelZip.�
2-1>,L' 7 Z Wh Number
Telephone Nu ber
­741,2ty t
Date Date RECE1vuc)
(Revised 61IN012)
MAY 21 2021
DCM-MHD CITY

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