Harris, Robert 84515C

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I* °j(OA 41 [ICAMA ❑ DREDGE & FILL N9 84515 A B C D
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Previous permit
GENERAL PERMIT
y Date previous permit issued
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.deq.nc.gov/CAMArules
Applicant Name
Address
-7
City State ZIP 0 i 4Y.1
Phone # ( )
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
❑EW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
Authorized Agent
Project Location (County): i,'.. YJ
Street Address/State Road/Lot # s
Subdivision
City i'%J 1i ZIP
Adj. Wtr. Body.
❑ ES ❑ PTS
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body '4't V Vd(
Type of Project Activity ^', Sj } J Sili•, Q V) A) 12' x 12' Alii L `t f,/'V At'J' F- XI ; T I A""rp
(Scale:
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) ', . ! V
Total Platform area l(nt)
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 n
Moratorium: n/a yes no {
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: 'N 112
Permit Conditions
C^ r•l r, 7 i
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ 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)
j
Agent or Applicant PRINTED Name Permit Ofi.cer's? INTEQ-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-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

1*E`tOSr"1&❑CAMA ❑ DREDGE & FILL Na 84515 A B C D
o
z = GENERAL PERMIT Previous permit
Date previous permit issued
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.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no 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
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes hoj
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
t, t
(Scale:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ 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
t
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:
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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0 1

AGENT AUTHORIZATION FQR CAI41 PERMIT AI�PLI ATION
Name of Property Owner Requesting Permit: p
57
Mailing Address:
Phone Number:
Email Address: C
1 certify that I have authorized MLCU
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: � a, -
at my property located at/ %I ���= f - j
in � County.
1 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.
Property 0Wner Information:
t
Signature
C
,�1 Print or Type Name
1 L-OJ I f r`
Title
�o //S 1wy
Date
This certification is valid through 1 1

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONf
(Top portion to be completed by owner or their
Name of Property Owner: _f� L
Address of Property:
Mailing Address of Owner: _ j_�-M Ave
GU
Owner's email: rd)er % Cj j-ri`j Lf4I ' OwnY%)
er's Phone#:
Agent's Name: @}r)f'MOrtY i Qf 00/C Ag nt Ph
FORM
_N 1-bn?7�u I
D511&
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICAilON
I hereby certify that I own property adjacent to the above referenced property. The tr)'dividuat applying for this
permit has described to me, as shown on the attached drawing, the developme6t they are proposing. A
dest:i�tton orrawing with di
dmensions, 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. . 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 yohave been notitled by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
;11 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,
V `- �N the appropriate blank below.)
i )-,*,I i DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Qrvner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
y� Typed/Printed name of ARPO: V1 i Lt''� N
bn Mailing Address of ARPO:
yr�
�.�
ARPO's email: n (41� AgrARPO's Phone#:
Date: D *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

W.C. DIVISION OF COASTAL MANAGEMENT i
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Ownei
C
Owner's email: MLLnLf!CI�Twner's Phone#: ��
`[ ` J{o . Qf,7&
Agent's Name: 1L ] j e O C -� yl (� g nt Phone#:
Agent's Email: u . o l) MCA) , GC,
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be comnieted by the Adiacent ProDertv Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
�b 6 permit has described to me, as shown on the attached drawing, the development they are proposing. A
n es ' tio=NOT
dimensions. must be provided with this letter.
V bjections to thisproposal. 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 (OCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557.00M 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
�1 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 slan
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property, wner
-OR-
I do not wish to waive the 15' setback requirement (initial t e blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: _ hbiliJ't:
Mailing Address of ARPO: 7�0� d
ARPO's email: t/1"& {/i'QA4: f1& 5104 •C#--ARPO's Phone#:
Date: r*d -W aiver is valid for up to one year from ARPO's Signature"
Revised May 2027

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