Davis, Robbie 84145C

NX�F COAS/q� N 9 84145 A B C D
,o f�CAMA El DREDGE &FILL
GENERAL PERMIT Previous permit (�
y Date previous permit issued
❑ New ❑ Modification Complete Reissue ❑ Partial Reissue
As authorized by the State of Nil Carolina,, D�artment of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
a15A NCAC ` ❑ Rules attached. I General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
n . ,. .
Applicant Name
Address
City
Phone # (�
Email
Authorized Agent ( &'Ak 11-ANil /' t 4 W I %—t
Project Location (County): cp�� �:f
Street Address/State Road/Lot #(s) i
Subdivision
City ZIP
Affected cW Es ❑ PTS Adj. Wtr. Body man/unk)
AEC(s): OEA ❑ IHA UW SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: ye no PNA: ye o
Type of Project/ Activity. OF o S > I J
(Scale;(V4 )
Shoreline Length 2
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area l
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore ' �6 "U
Breakwater/Sill
Max distance/ length�--
Basin, channel
Cubic yards f y
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other /
f
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by: ��. t 1�- [
Permit Conditions Ifl CY r
"F rf�l0 "-5 ( ' 7
Ap lication Fee(s) Check #/Money Order
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back

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 RE
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
�s
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 4 Z2°
at my property located at
in County.
I 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.
Prop Owner Information:
Zpaof,5
Signature
L'eL�- z2e&/ �'
Print or Type ame
'_7 /
Title /
Date
This certification is valid through / / RECEIVED
Nov 0 9 2021
DCM-MHD CITY

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