Horton, Donnell 84519C

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`°"S'^/ T❑CAMA ❑ DREDGE & FILL N9 84519 A B C.
3 GENERAL PERMIT Previous 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 C, '1 E' ; ❑ Rules attached. ❑. General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name'
Address
City State ZIP
Phone #( !0 j 1 3 124
Email
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS
ORW: yes/no PNA: yes/no
Authorized Agent "�trylJ (.:' /� }(`'r •tii,'..
Project Location (County): ��'J•S �� i�.
Street Address/State Road/Lot #(s) i /' } (.- ( 4-i_ l !tf r
Subdivision
City ZIP ,� t&-O
Adj. Wtr. Body " `M U) GHA NJVL _(nat/man Unk)
Closest Maj. Wtr. Body > flu
Type of Project/ Activity ,i Al2 f ' /t o
(Scale:
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 no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be
Permit Conditions. y ^yrt i oy— i u,�; �} cbaAAA) .1 :, w ,)
r
/ i -A } 3 +� /'�� fi• i' j �PHO O/ VA, Jb9V? - V S Wt L yCq}(�1/`�'T"
t_i r"iPf�sl"JA�v �/\1_� 4,
U iAn/rAm/rvtuat/DurrtR kc+rclU vrlB/
❑ 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 ,
!/
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

a* 0I COAST41 & i Previous permit EICAMA F1 DREDGE & FILL Na 84519 A B C D
41 GENERAL PERMIT Date previous permit issued
New F-1 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: ji
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.,govZCAMAruIes
Applicant Name
Address
City State ZIP
Phone #
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City -
Affected F]CW REW EIPTA FIES OPTS Adj. Wtr. Body (nat/man/unk)
AEC(s): F-] OEA R IHA DUVV D SPIMA D 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)
(Scale:
Total Platform area . .... .... . .
Groin length/#
---- - --
Bulkhead/ Riprap length .... ... ---
Avg distance offshore
Breakwater/Sill
A-11-1 -i--- -
Max distance/ length
-
Basin, channel
T—
Cubic yards
... ....... .
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing ........ . ... ---- ------ -------
-- ---- --- ---.. . ..... . ..
Other
SAV observed: y es no
Moratorium: n/a yes no
Site Photos: yes no i i T
5 -ili
f IN
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
ElSee 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
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 F� 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

��aGEtti I AUTHt7r=�!7._ATf� FJ C,Gf1�A r'EF?` I� ��'r•'l_!C �l Ill!
Name of Property Owner Requesting Permit:
Mailing Address: 5466 SD►weg—LVL-
40dS64111 ,
tic, 7
Phone Number;
Email Address: O�nh►�cdOh��a�t�o: awl
certify that I have authorized � 1A 1AL` r
Agent /Contractor
to act on my behalf, for the purpose of applying for ano obtaining all LAMA permits
necessary for the following proposed development:a a
at my property located at I
in�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.
Property Owner Information:
Signature
DO n n Pl I L --H a r to ha
. Print or Type Name
Own -or
Title
/ZS/202I
Date
This certification is valid through I

ADJACENT RIPARIAN PROPERTY OWf NER STATEMENT
I hereby certify that I own property adjacent to s
(Name of Pry erty Owner)
property located at . I I /�J u s
(Addreds, Lot, lock, Road, etc.)
on , in � g D , N.C..
(Waterbody) I (City/Tow nd/or County)
The� �applicant has described to me, as shown below, the development proposed at the above location.
' - - I have no objection to this proposal:
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the setback, you must initial the appropriate blank below.)
40, I do wish to waive.the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature Sr tuxe.,� ,
Dann Q 1 I `[I cr`� o Irl � .
Print or Type Na e Pn' t or Tye Name i
. 145M 'lin Address. M ilin Address
iT-TO-d5a►1 Beach .KIC2s4[o Z`I P) .)"):f- a -� a
City/stat /Zip City atelZ p
sod - 773 - I5� 1 _ ' -
Tele hone Number Telephone Number
7� l $-lam -�/
Date Date
(Revised 611812012)

I

ADJA2ENT IRIPARIAN PROPERTY OWNER STATEMENT
I hereby certify ftt I own property 0j . acent to Muniml is
iu.;;;. f Winnarow
property Ideated St'. 146' .01J V111me )-A - R, ffiuh Alt IM0
(Addreds, Lot,BIOCK
--j- raj ja it Alt Ma
on In
'(Wtbrbody)' (Ckyfrown indfor 0"nty)
The.appReanthes
_deschbed to me, as shown below, .the development proposed -at the above.locstion.
I have no objection to this proposal.
.1 have objeWdns to this proposal.
(McMdual
DRAWING .OP PROPOSED IDEVELOPMEN I ,
mdst A114n dwcrfptfon below or Mach a site ~nW
WANE' SECTION
I understand that 9 - pier, dock, mooring pilings, Oreakwater'r, boathouse, lift, or groin must be set- back a-
6 0 wit -to minimum dieahm, of. 16'rrom my area of. riparian access unless waived m (it you ft waive
the setback, you must fnM I the date blank below.)
I app-rpp
I do z wish to waive. the 15'setback requirement.
I. do- not wish to waive the 16' setback requirement
(Property O%A6or iiii-tormatloh). jA� P pe Owne n#oimatianj
Si ff 'A
e. Si
Print or Type Narint N
145 DIT V­0 Inap, Ln h' dij
li Mai! g Addirpss
'Ws
Doe
fany/ow"*W�-3
Date
(Revised &18202)
0

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