Dietz, Adam 84112C

1* ,j COAST,4, &.0CAMA F-1 DREDGE & FILL N9 84112 A B C -D
Previous GENERAL PERMIT permit
Date previous permit issued
New []Modification F-1 Complete Reissue ❑ Partial Reissue
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:
15A NCAC F attached. Rules aached. El General Permit Rules available at the following link: www.deq.nc.goy/CAMArules
Applicant Name
Address
City ,I I,,,/
V.�
Phone # 1)'J
Email
Affected 1-1 cW
AEC(s): F—] CEA
ORW: yes/no
State -ZIP
11 EW 11 PTA
0 lHA 0UW
PINA: yes/no
Type of Project/ Activity
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
FIES OPTS Adj. Wtr. Body (nat/man/unk)
SPIMA ❑ PWS Closest Maj. Wtr. Body
ye
(Scale:/::'
S ore ine eng,
Access Length
Pier (dock) length 7-, 5"o
Fixed Platform(s)
... ...
....
TT
07
Floating Platform(s)
0.7
—
—
------
—
—
—
—
—
—
—
Finger pier(s)
Total Platform area
Groin length/#
—
— - - -
-----
- ----------
Bulkhead/ Riprap length
----
----
Avg distance offshore
Breakwater/Sill
—
—
— ---
—
—
—
—
—
Max distance/ length
Basin, channel
Cubic yards
. . ..
.......
—4
Boat ramp
Boathouse/ Boatlift
—4—
--
—
—
—
—
—
Beach Bulldozing
. .. ... . ..... . .
-------
—
— ----
Other
Y, 2
—T—
SAV observed: no
;ell
yes
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building nermit/zonine permit may be reauired
bv:
A ^C
1 ^
1f
Permit Conditions
L_Lj 1AK/VAM/Nt:UNt/t5Ur-r-t:K (circle one)
0 See note on back regarding River Basin rules
ElSee additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
F] Tar - Pamlico River Basin Buffer Rules 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

t°"Sr", FICAMA ❑ DREDGE & FILL N9 84112 A B C D
0
2 GENERAL PERMIT Date Previous Date previous permit issued
0,F-]New []Modification ❑ Complete Reissue ❑ Partial Reissue
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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.de.nnc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # (_ )
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
❑EW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp " r
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
yes no
Moratorium: n/a
yes no
Site Photos:
yes no
Riparian Waiver Attached:
yes no
A building permit/zoning permit may be r
Permit Conditions
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Subdivision
City ZIP
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
(Scale: % `)
u I FV Vn1- way/wI i 1-1 k—sic --1
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s)
Check #/Money Order Issuing Date
Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
F� Tar - Pamlico River Basin Buffer Rules 1-1 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: )43Nffd 7/K7�-
Mailing Address: ��5� ©/Z) �i�l �r•P �-C ��'
Phone Number: /i ' y"r, of i a J
Email Address:
I certify that I have authorized �� a:,,r s 61,w 0W-0.3 G �-
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CA/MA permits
necessary for the following proposed development: z /U s �a-Gl D PC,(,,
at my property located at j efS LN , owd; e ae:L'A
in .v County.
1 furthermore certify that l 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 Own I mation:
01 Signature
0(./4--j
Print or Type Name
Title
6l —mil
Date
This certification is valid through_l�l_

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CERTIFIED MAIL , RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIP- RIAN PROPER T Y OWNER-NOTIFICATION[WAIVER FORM
Name of Property Owner; d q/044
B /
Address of Property: 0 BGa s r_'ca i(,' e (,,,ee
(Lot or Street #, Street or Road, City & County)
Agent's Name #: )/ty C4 - Mailing Address: /?.fib Ia�•aQ
Agent's phone #: J S Z 7 2 a= 013 Z �,,, �GL C L4-5,
i hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
`� ;:." q='WiTtainerrsiansu€bi'rav d.etinufihtts live.
They are proposing. Aydscrtpttono;drawr�_
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Managem. on
(DCM) in writing within 10 days of receipt of this notice. .Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 26557. DCM representatives can also be contacted at (252) 808-
2808. I response is considered the same as no objectlon if you have been notified by Certified .Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 1 5' 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 t 5' setback requirement.
I .do not wish to waive the d 5' setback requirement.
(Property Owner Information)
Eignatur e
A-D,4144
Print or Type Name
sl ,c " a
Mailing Address
L, -. I6,t.� ;! r,',�9,, asp z
City/StateOp
o8'C)
Telephone Number
Date
(Arent Property Own° Information)
Signatyre
Print or Typ6 Name
Mailing Address
City/Sta e ip
3'�z--7
ne Number
Date
Revised. 6/18/2012

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CERTIFIED MAIL a RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
_.. - ADJACENT RIPARIAN PROPER T�e OWNER-NO-TIFICATIO IWA VER FORM .
Name of Property Owner: Jd,kti�
Address of Property: B��►
(Lot or Street #, Street or Road, City & County)
ea- f-5
/�
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
`;••:s�••-<'3:sc�.;*z��:= �r-y,rns�..�i'r_•'�ii�'�,*�wP'�`�I�:"4=+�-^�';:3'm��,�'��`,.,
they are proposing. Ard: scr•.iption or drawfng w:wIT dlrnerts�ons rrtusi be pray tl.e wtfifl r l €e .
40 V I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCNI) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557, DCM representatives can also be contactedat (252) 808-
2808. No response is considered the same as no objection. if Lou have been notified by Certified Mail.
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.
(Property Owner Information)
Signature
h� 'D e,
Print or Type Name
Mallina Address
S �—
City/State%Zip
q 19 4-k K rmr- 0
Telephone Number
Date
(Adjacent Property OwneE information)
Signature /
Print or Type Name
�el
Mailing Address
City/StatelZip
A6';� ?38 66��
Telephone Number
I, ?-,t
Date
Revised. 6/18/2012