Purser, David 84854C

. .................. . ... . .
*to"Zq LAMA 0 DREDGE& FILL N9 848,54 A D
4 Previous permit
411vcGENERAL PERMIT Date previous permit issued
New 0 Modification F] Complete Reissue El Partial Reissue
As authold !byythe State of NoytlyCarolfna, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
4.
15ANCAC—.----�7 E L n Rules attached. General Permit Rules available at the following link. vc�.nr.�v C#—,MALwJe-s
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W A
State Applicant
Name
Address
Applicant Name
City �4 State Arr zip
Phone #
Email
Affected D cw w 0es PTS 15m E]
AEC(s): OOEA I IHA El uW -] VIMA PWS
ORW: yes/(o PNA: ye
Type of Project/ Activity (K
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #Ls)
41i 1103 5
Subdivision
City, 3 &J- �Zip
Adj. Wtr. Body
Closest Mal. Wtr. Body
FM
Shoreline Length (ScaleAp
Access Length
Pier (dock) -length
Fixed Platform(s)
Floatin Platform(s
Finger pier(s)
Total Platform area
Groin length/It
Bulkhead/ Rlprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
C„6i. y—do
Boat ramp
Boathouse/ Boatill't
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 70,
Permit Conditions
q-�-k -) (- �l1--t I (") 'L011-
gent or Applicant PRINTED Name Permit 0' -c r'st . ELF Name
�71ina ase ad c dances back of permit— Signatur
3
Application Feels} Check it/Money Order issuing to
TAR/PAM/NEUSE/BUFFER (circle one)
F-15ee note on back regarding River Basin rules
1:1 See additional notes/conditions on back
(Please initial)

,FCOArN''�s CAMA ❑DREDGE &FILL 2 1e`� �0� NQ 84854 A C D
Previous permit
m GENERAL PERMIT
Date previous permit issued
New ❑ Modification [:]Complete Reissue []Partial Reissue
As autho zed by the State of No Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
F
I SA NCAC I qZt/ ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City *()
Phon
Email
C,r
ZIP
Authorized Agent
Project Location (County) VL�'--
Street Address/State Road/Lot
�t
Subdivision
City ZIP
Affected ❑ CW EW PTA ❑ ES ❑ PTS Adj. Wtr. Body / dou ,oV,,/ nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body U "
ORW: yes/n PNA: yesAl/
Type of Project/ Activity ( 0 6 23 .1� ep("' C
(Scaler
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s) J
rr
Floating Platform(s
Finger pier(s) P
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 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 m
00
Permit Conditions
i reA by:
N2) I. E/^ f-.,-
�r
'JC tU ❑= TAR/PAM/NEUSE/BUFFER (circle one)
i �
❑ 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 REVI
gent or Applicant PRINTED Name Permit
Signa a **Please ead compliance statement on back of permit** Signatu
12
3 ❑ 1
Application Fee(s) Check #/Money Order Issuing
E STATEMENT. (Please Initial)
Name
P4 ir\-A
ExpirationrDate

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

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
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Name of Property Owner Requesting Permit:, �/� V 1 D (_.-. tt (;� Jc l�ctiLr
Mailing Address: - (_ j'y`i 'S4 ,
tJJ an s (� o v-- 0 /� L K S `�
Phone Number: I g' D q?K a, 11 1'_,_,,I ff- 7.3/6_
Email Address: cJebpur-sc{ Mki 1, CorR
I certify that I have authorized sujj'T\u-- S
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: buy___
�� I 1 �
at my property located at tr- a ,
in S1 0 4) County.
I furthermore certify that I 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.
b.\,,:C'("gr'
ure
Print or Type Name
F R
Title
—` l
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT" REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner j=i V/ �-) -, �: R) %<i-:�—E-
Address of Property: Igol_� al-J. `S• . j�? I} }`j� r s'
Mailing Address of Owner:
Owner's email: o l yJ (��� ��g (}��rJ Owner's Phone#: �. J� 7 ` ' �� r `L f i ; i ': "�' S>
ents Name:
A 'r (r
g '1_ � .�'�y�"�,�'�_ � � Agent Phone#:_ t /_� i k (_? }-t
Agent's Emeil:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that 1 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
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 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 [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 somelall of the 15' setback``�,
-OR-
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, � ="� �_�ji�,y✓'"�
Typed/Printed name of ARPO: _ C_ 1�_ /' (9-1 0 . - oy 1 e PJJ? t i iJ. fit. -
Mailing Address of ARPO: _ K A-,
ARPO's email: C j���ARPO's Phone#: 2- d
Date: -ice -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 NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property: l� 5 C� Ai �p� aLn"seceo Q�, C_ psl�q
Mailing Address of Owner: �' J \\
Owner's email: V5 C l . Owner's Phone#: Lq tg 1 Q V� ' (}4* cq
Agent's Name: t i. iMAS Agent Phone#: l 'L 2� i� L4 J84
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 Coastal
Management (DCM) in writing within 90 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 rlprap revetments). (if you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the I V setback
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank) 4g 11-T
Signature of Adjacent Riparian Property Owner: 444, L
Typed/Printed name of ARPO:
Mailing Address of ARPO: `PO A-e f?f -t WZi%sJ!E.Mj /L A-P�'f
ARPO's email: Lc�iWi�t�,�Jt,i��o�mARPO's Phone#:
Date: 4Z14-L-4p� ''waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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