Blakely, Dodie 84341C

aAMA ❑ DREDGE & LL IT 84341 A B
-Am
y E N E RAL PER Previous permit erm►t issued
$New ❑ Modification ❑ Compl to issue ❑ Partial Reissue
As authorized y the tate f Nqr Caroli a, Department of Environ Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC (�1}J`` Rules attached. General Permit Rules available at the following link: www.det.nnc.gov/CAMArules
Type of Project/ Activity
Floating Platform(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill----�"
Max distance/ length
Basin, channel �--�
Cubic }cards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other I g.Q110 aL
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Atta
A building permit/'zc
Permit Conditions
❑ iAR/PAM/NEUSE/BUFFER (circle one)
see note on back regarding River Basin rules
❑ See additional notes/conditions on back

oX\jOAR"1 AMA ❑ DREDGE & FILL N9 84341 A B
E N E RAL PERMIT Previous permit
y - Date previous permit issued
New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized y th!tatg N r h Caroli a, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC❑ Rules attached. N(General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
w
Applicant Name
Address .
City
Phone #
Email
Authorized Agent
mil FA WWII
Wl •ps'►��L� .. -
Affected CW EW PTA ❑ ES ❑ PTS Adj. Wtr. Body (naV n/unk)
AEC(s): OEA �IHA UUW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: 60
PNA: yes/,C nn
Type of Project/ Activity
Floating Platform(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift -
Beach Bulldozin�g++�
Other W —X A M Cf AA, _ _
I AM AWARE OF STATUTES. CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVI
A eg rat or Applicant PRINTED NaiTe--
ig ture ***PIDo compliance statement on back of per
T� % (0
plication Feels) Check #/Mone Order
Permit
Issuing
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
Initial)

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:
1-1 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:
Mailing Address: ��tJ/VA/� 'AJI L ��
Phone Number:
Email Address:
e w v r G .22
2
I certify that I have authorized `fit' p(f c' I
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
PI, <f-,r
at my property located at C//V'V AJ
in L C County.
L'CAA)(Z'
I furthermore certify that / 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:
Signature
Print or Type Name
Title
Date
This certification is valid through / I
RECEIVED
my 1 % NZ1
DCM-MHD CITY

1 y - R

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f ProperWner
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�76
property located at 6 (Addy
on s, Lot, Block, bad, etc.
G'� �L— in
C� N.C_ -
{1Naterbody) � (Gityflo�(n an for County)
applicant has described to me, as shown below, the development proposed at the above
The pp
location
( have no objection to. this proposal.
DESCRIPTION AND/OR DRAWING QP PROPOSED DEVELOPMENT
uai proposing development must fill in description below 7rach a site drawing)
In" d A P
I
�l ('�VAiVIsR SECTION be set
t
understand that a pier, dock, moon m
ring pilings, breakwaanrab0essounless wayedift, or usej,bymet(If You
area of ripanw6ack a minimum distance of 15' from my appropriate blankbalow.)
C wish to waive the setback, you must initial the aporb, P
_ I do wish to waive the 15' setback requirement.
- ---�- I do not wish to waive the 15' setback requirement_
nt Property Owner Inform
(Property owner Information)
(, ' ion)
ck e�
Sib attire � � ,�
b o I - print or Type dame
print o , e Name
ti A.) . M ding Address
a'' g Address S� > JC�'1^
fins Gv -{- /� a- City/St 'e ip Q CJ C 6-8
City/State rp� C�
5. Telephone Number
Telephone Number I -_ �
Date RECEIVED
-Date(Revrsed 6/18/go12)
NOV 18 2021
DCM-MHD CITY

I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 1
`'' . E' / ' s
I hereby certify that I own property adjacent to G ( ame of Pr r fn ) �% C" -2
properly located at 0 ! � U R) I" o ; N 1 L.G'�
(Add ss, lot, BI ck, Roa , ets�!) N.C.
_ C
'�-. sc� u N �n y d/or County)
�n U tl (CityRown an
low, the development proposed at the above
The applicant has described to me, as shown be
location —
I have no objection to this proposal.
i_L,avobl.�ctio"a'tQtLtis_prap S,-)I-- --- -_. __--
DESCRIPTION AND/OR DRAWING dFePROPOSED
R POSEDlo DEVELOPMENT
oEaOa h a Site drawing)
(fndtvi ual proposing development
I v �
p 5 c p oc ,`0,7 Sv N A,
WAIVER SECTION --+_ i
V , N pilings, breakwater, boakhouse, lift, waived
groin must If ou
I understand that a pier, dock, mooring p 9
back a minimum distance of 15' from my area of riparian access unless waived by Y
to waive the setback, you must initial the appropriate blank below
-Nish .)
TOi do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
< 1� I CL
Pnnt or Ty ejNIame
J U
htai!'n Address
City/State/Z p /
i stephone Number
� Date f� t
(Adjacent Property Owner Information)
Print or Type Name c/vc G S ✓, i�� r
hla g Adddre s
Citylsta ip
Telephone Number
Date
(Revised 6/18i1,1012)
RECEIVED
M
NOV 18 2021
M—MHD CITY