Dixon, John 80564C

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue El 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
Na 80564 A
Previous permit #
Date previous permit issued
❑ Rules attached.
B C D
Applicant Name
l.' ` `- j %f,
Project Location: County :, ,. ''"'- ` rr
f1l
Address l` �
0 1, ���� r` /,j`
Street Address/ State Road/ Lot #(s)
City �; . >,,
•��-, State ZIP, {
Phone ( )E-Mailr
4—or",
Subdivision -
Authorized Agent'�''
City .'t 1 ,r, , ( 1 (.
ZIP ifi l
Affected ElCW
❑ EW ❑ PTA El ES ❑ PTS
Phone # ( ) l River Basin
AEC(s): ❑ OEA
El ❑ IH ElUBA El N/A
Adj. Wtr. Body { _,
y ` ' nat /man /unkn
ElPWS:
Closest Maj. Wtr. Body
ORW: yes / no
PNA , yes / no
Type of Project/ Activity
(Scale:
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) j
Groin length
number
Bulkhead/ Riprap length T
avg distance offshore -
max distance offshore
Basin. channel
cubic yards
Boat ramp
Boathouse/ Boatlift!
r
Beach Bulldozing
t
Other
`f
Shoreline Length
SAV: not sure yes no
t_
Moratorium: n/a yes no
E� r.. 3 ..r•P^_
_ — a
Photos: yes no !
N•�
VI
Waiver Attached: yes no 4" —
r
A building permit may be required by: y, ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature 'r* Please read compliance statement on back of permit ** Signature
Application Fee(s) Check # Issuing Date Expiration Date

r.,
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 haw 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/ 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
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

❑ CAMA / ❑ DREDGE & FILL N19 80564 A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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.
Applicant Name
Address
City State
Phone # ( )
E-Mail
Authorized Agent
❑ CW
❑ EW ❑ PTA
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH
❑ PWS:
ORW: yes / no
PNA yes / no
Type of Project/ Activity
rler kaOCK) le
Fixed Platforr
Floating Platfc
Finger pier(s)
Groin length
number
Bulkhead/ Rip
avg distz
max dist
Basin, channe
cubic ya
Boat ramp
Boathouse/ B
Beach Bulldo:
Other
Shoreline Ler
SAV: r
Moratorium:
Photos:
Waiver Attacl
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
ZIP
❑ ES ❑ PTS
❑ UBA ❑ N/A
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: r :-, " ( / )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature ** Please read compliance statement on back of permit ** Signature
Application Fee(s)
Check# Issuing Date
Expiration 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 [)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 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/ 1-888-4RCOAST 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: John Dixon
Mailing Address:
Phone Number:
Email Address:
6904 Canal Drive. Emerald Isle NC 28594
919.923.1357
john mic [e-mail]
I certify that I have authorized David Braswell /
Agent !Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
boat lift
at my property located at 6904 Canal Drive, Emerald Isle NC 28594 ,
in Cape Carteret 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.
Property Owner Information:
Signature
John Dixon
Print or Type Name
Title
08 104 12021
Date
This certification is valid through 12 i 31 12021

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M
A
N.C. DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND CJ>r_ 61VERy
(Top portion to be Completed by owner or their agent)
Name of Property Owner:
Phil Dixon
Address of Property: 6904 Canal Dr Emerald Isle NC 285984
Mailing Address of Owner
Owner's email: pdixon@clrrusinsight_com Owners Phone#: [phone]
Agent's Name: Agent Phone#:
Agent's Finail*
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
($49ttom rtlon to be completed- h th Ad acent Pro ertOwner
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawi jg. ith dimensions. must be prnvid d with this lett©r.
X 100 NOT have objections to this proposal. _ I DO have objections to this proposal.
tf you have objections to what is being proposed, you inust notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at {252) 808-2808. No response is considered the same as no objection it you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat -amp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my areA of riparian access urless waived by me
(this does not apply to bulkheads or hprap revetments), (if you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
Signature of Adjacent Riparian Properly awrier
w y
I do not wish to waive the 15, setback requiremont (initial the blank) me
Signature of Adjacent Riparian Property Owner: ( -
_---� "`✓
Typed/Printed name of ARPO: Marlyn Easton
Mailing Address of ARF10: 604 Foxridge Ct Lenoir NC 28645
ARPO's email: mneaston c@t. Maa.corn ARPO's Phone#: [phone]
Date: ?$ Aug 2021 waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:L
Address of Property: d/) a
Mailing Address of Owner: v`�
Owner's email: jilt i\I �Cq,�t�t�f+r wner's Phone#:
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastai
Management (DCM) 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 contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: / f2, c /l/G tiU--E'
Typed/Printed name of ARPO:
Mailing Address of ARPO: 5 71 IV C C/'�o �'t w�)' ��/�sv.�il� /V C �?7 �5 `?(0
ARPO's email.' Iw43e& Nc • Rrz, ARPO's Phone#: 91 �% - 2 / 4-1- -3
C o "-I
Date: i 'waiver is valid for up to one year from ARPO's Signature"
Revised May 2021