Branch, Jay 80683C

fFE'
GE& FILL ,- 80683 A B C D
RAL PERMIT Previous permit#Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality n l acdO
and the Coastal Resources Commission in an area of enviro mental concern pursuant to 15A NCAC J'rl
�. Rules a ched.
Applicant Name Project Location: County n4
Address `'T Street Addr ss/ State Road/ Lo #(s)
City U StatetK) ZIP
-bmc
Phone # ( E-Mail n Subdivisi
Authorized Agent 'CJ City ZIP
Affected ❑ CW �W TA ❑ ES ❑ PTS Phone # rRiyerBBasigaRtkn)
AEC(s): El OEA HHF I ❑ UBA ❑ N/A Adj. Wtr. Body fit❑ PWS ^5^ /man un
ORW: yes / o PNA yes /
Type of Project/ Activity -
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshort, —
max distance offshore
Basin. channel
cubic yards,
Boat ramp ` , ,
Boathous / oatlift 4� 7
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes ho
Moratorium: n/a yes 1 no
Photos: yes
Waiver Attached: � s n
A building perrmTt r ui Y:
( Note Local Planning jurisdiction)
Notes/ Special C�pJditions _
11 $,r
n
ure * (nasad compliance statemento back ofper(miit"
V
r—
Ypplica—tion Fee(s) Check #
Closest Maj. Wtr.
i
Signatu
Issuing
❑ See ngte on back
(Scale:
River Basin

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/ 1-888ARCOAST 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
2-; Z-S.-31 Z':� i0
I certify that I 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:�Tl��-mot L �✓� �� `�E'�/
at my property located at
in L*—A >A -r,jT— 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. (-"0 —1,
Property Owner Information:
signature ✓
Jn Y
Print or Type Name
Title
Date
This certification is valid through !
AUG 2 5 2021
DCM-MHD CITY

I hereby certify that I own property adjacent to _
property located at 1 1 6 I PO A''
(Address,
on ua iu 4 L-- , in.
(Waterbody)
Y- --> r ►0 < I1
(Name of Property Owner)
o k, Road, etc.)
(City/Town and/or County)
I
N.C.
The applicant has described to me, as shown b low, the development proposed at the above
I o ate ion.
I have no objection to this proposal
DESCRIPTION AND/OR DRAWING i
(Individual proposing development must fill in
QD
l 1 C 4-
PROPOSED DEVELOPMENT
scrintion below or attach a site drawing)
_ WAIVERS ECTION
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 a • propriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setba7,pk requirement.
(Property Owner Information)
Si ture
.,\i4�-' -jrY1�. �
P(ri I or T e Name
6 '
ailing Address
C /StatelZip
Telephone Number
Date
(Adjacent Property C
Sign atu . 1 f
Print or Ty e ame
Mail•ng Address
►/ 1" I l\ FJ- C
- , .- C A 7,
Telephone Number
Information)
113
(Revised,%,,1C 1j%2/1�?
CITY

�
... ..
f
�_
s
, ,�

NT
I hereby certify that I own property adjacent
adjacent to _
property located at
(Address,
on-i'i`'-t , in
(Waterbody)
's
( me of Property Owner)
3 oy�Road, etq.
>l i C , N.C.
(City/Town and/or County)
The applicant has described to me, as shown bE low, the development proposed at the above
I ation^
I have no objection to this proposal
DESCRIPTION AND/OR DRAWING
(Individual proposing development must rill in
0
0
PROPOSED DEVELOPMENT
scription below or attach a site drawing)
��` I I (s
1) 6 (_, lC_
I understand that a pier, dock, mooring pilings, b eakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area ol riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
1 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setba k requirement.
roperty Owner Information)
L- c )-1
or
Maili g Address
0 .
(/Statelzip
5 _5_ l �F
Teleph n� Nutrtb r
Date
P
Sr a re
lbtjr T e Name
L) 'v
Map' a Address
City�---/ llte/Z�ip
Telephone Number
Date
(Revised 6/181)� 2021
DCM-MFID CITY

t

.5 51 s
o m C7d ll -d- h !y O q 0 w Vr'i
c� co � �, � � rn � c
a= h a a ti a d r ti :L y O c�D cD
d yy ► y I..
tTj
r
a s m w ~ \ �p O ;C � rrJ '� r;' r� 9 W � �• � y�'' [rJ Vi � Imo+
o-00
Uhl Nro
N �r1 0 j y '�. C7 W irk ►�
o N \ O
2 m W �7 CJi �l W r-' x N O� td'�' N 00
N Ci
w .o o �y �1
N 00 co p UO 'y—' pNp Cl)
NO
M o *4
0
a r
UlrA
0
a 8
m=o N rt O
a m N
o OO V O to,'+ V
� ¢' Ui V"' N
s O Co W
ym N 4�1 O
am..
m
n � N
6
i
aye II Z 1
oa f
a
a i all
q ( A t
(D ,
F
! fT
O N 1r -
0
�o
ANEZ,
65
01
4LN O' S• 6a 91it #•!
av
O J
_ O rat - F � $li q„ � S�"� . � _ •

,1
Tf
cFr
" rI
ytFL _ ''.:lti�''� �`it S'(^•L w'�d. I' 347,E '� h�lLr, c `s'I +�� ��L u ;* 6�x�
ifV.U�•K fT - tti< <>s� d `WO
IN i•., ,
IS - �
Y ,,ma�yy
kk
OC
r 3�
r
:`Y!X � '�' i a .a ! r r+�i`,'S'�. YA -5� t'_` � �� � � _ .� s ! l��l�.p�! �,.I . ., j •'•� _
':.:4 b -i 1� �'� !u :b ! L � ,•?�iYJSalK�f! .�r''r �f 1f c - k�,-� i�� it �Y" ;! � '� -
TA
' r affi`- x f -F�L n'•.'YP I � ��� 1�-f� ',� � ��� � ` 1 -.. • ' � r� ci ��L q..<'-i�•. �1 T
. I i 5'a s r f i SSS J f f
1',
IV
��: +r. _ - ♦♦'ll j1 .. n /{[tea 1 �4!r: Y�� ° � to � 4 - � ��" ,f. Y
�y •:77k 3T�1 4 � �, 1 •4, � r3-'S� >x ! lY �i
! 1•...4 jt 3�, � : ..1 <a� ti't`- ,.$°��i ,�71 � � w^ L S � '�%� - � � rys i 2� I
' ,.-' r 4 v �.'-�i �r7i Y s, i `° s. ik;?J}�t �.f2�.y ._� �1,. •. ,��,ssF
Iq{t �- r �``� -.. 21'r '� '�' ' �.F � l �>•�`1�5�tiiL.'w�t`p}�$' K �".'
H� � i p� A l !S L � 'S l �_nF� � - °•.� r �j� ( ���-��y� # ,"? � g Y I` j. yrV L t;'
"�'�aw• w.t�';'� }� ritrf � - I�� r�� � r cy � -A'"` � � t � 4 i•.... r%.� �
4.-�!•I >•. �a5. �`:' t i',��1 I ` Lin! 4 �,y7l�r - i qq+�1 �',k �W 1•
n _
Fj.-