Soloman, Jacqueline 80485C

❑CAMA / ❑ DREDGE & FILL N9 80485 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 I SA NCAC
D Rules attached.
Applicant Name ) (faz Project Location: County
Address % i, t' ',/� Street Address/ State Road/ Lot #(s)
I ,1iA1
City��� State ZIP i
Phone # (
E-Mail
Subdivision
Authorized Agent {) l i R LA ZV 0 r) >'v' 1 City „j -1 1( ('%'( i ZIP
Affected ElCw ElEW ❑ IP' A El ES ElPTS Phone # `( ) IY�/? ' %�f' :River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body-)�'�-' _:�� ((t /man /unkn)
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Permit Officer's Printed Name
Signature
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 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, certify that this 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 howto 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 N9 80485 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 ZIP
Phone # ( ) E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
I Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number -I
Bulkhead/ Riprap length j
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
i
Other
i
t
Shoreline Length i
SAV: not sure yes no --
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no -.. --
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
i
(Scale:
t
❑ See note on back regarding River Basin rules.
PermitOfficer's Printed Name
r
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 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, certify that this 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 howto 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 -
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;
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
C
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: f i--
at my property located at ? ? e
in here i 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
Print or Type Name
Title
GV0 ehtck)
Date
RECEIVED
This certification is valid through C'L- I 5 I Z Z. JUN 07 2021
DCM-MHD CITY

f

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1. s
I hereby certify that I own property adjacent to l \1 04 er Owner)
(Name of Property
property located at 2- 5—;
5.3- .
(Address, Lot, Block, Road, etc. N.C. .
i6` r
on c�Z "� d int (CitylTown and/or County)
(Waterbo y)
s shown below, the development proposed at the above
The applicant has described to me, a
to a 9
l., I have no objection to this proposal.
have�bjecto_ns
NT
- -----= - EVELP
DESCRIPTION AND/OR DRAWING OP PROPOSED ow or attachEa site drawing)
(Individual proposing development m�us�t � �� descstp� n bel
ve `>
f
�olCi
WAIVER SECTION -
_ pilings, breakwater, boathouse, lift, or groin must be ou
i understand that a pier, dock, mooring p g
back a minimum distance of 15' from my area of riparian access unless waived by ( Y
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback. requirement_
( la ntproQerty Informatio }
(Property Owner information)
01-01
-Signature--`-
_i Pi me t
Print or Type Na e 1 ' Y\ U`-�-
Mailing Address 1f
f�%kl E City/Statelzip 1 7 5
Cit,(/State rp 5 ,
`I e _ is sl D Telephone Number
relepnone Nu b r �� —U 3- Z'U VED
b` 3 ~� Date
Date
''Re'dutii ty/Nif)
DCM-MHD CITY

4;

AN PROPERTY OWNER STATEMENT
ADJACENT RIPARI
's
�9J �
I hereby certify that I own property adjacent to �� rty ne
(Name of Propeowr}
5�f S .
property located at 2 2 etc
d
(Address, Lo Blo k, Roa, ) Pam- N.C. .
[.� � _.�---' .
on ' in(CitylTown and/or County)
(Waterbody)
- - ro osedat the above
The applicant has described to me, as shown below, the development p p
location
I have no objection to. this proposal.
_�l�Izj§��tion'5t_o_tL��no
QsaL------ --- ----
NT
DESCRIPTION AND/OR WING OF PROPOSbeloworattach a site drawing)
(Individual proposing development must Fill in des
crtpt�on
r
WAIVER SECTION
-- - - _ ier, dock, mooring pilings, breakwater boathouse, 'lift,
waived 'bymmet (If you
I understand that a be set
p area of riparian access unless
back a minimum distance of 15' from my appropriate black below.)
wish to waive the setback, you must initial the appro P
l do wish to waive the 15, setback requirement.
I do not wish to waive the 15, setback requirement_
(property Owner Information)
Signature
i1cc, -C60 r
Print or Type sNan?� sk-
22 �--`
iVtailing Address
oM 0A, c--------
Cit /StatelLip
�1g �.Iss
`elephone Number
3 ZI
Date
(Adjacent PTOPerty uwner „ --,,,....
Si anature
R0
Prim Vame
�, 1 S; All 1 T -5 T —
MailinAddress
A
City /State/Zip
Telephone Number
Die RECEIVED
wised 6118ROI 2)
JUN 07 2021
DCM-MMD CITY

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AGENT AUTHORIZATION CA _MA PERMIT. APPLICATION
Name of Property Owner Requesting Permit: C-
Mailing Address: 4�
Phone Number: -701 7
Email Address:
I certify that I have authorized 1-
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
�-t- e- IC'�f ee- 44-
at my property located at :7 3 5,,-,\1,
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.
RECEIVED
Property Owner Info
AUG 11 2021
Signature
Print or Type Name
Title
Z
Date
This certification is valid through

AGENT AUTHORIZATION FOR CAMA PERMIT. APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:j
Email Address:
I certify that I have authorized
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
r
at my property located at 2 2.3 5;�;� r'��"� c -';`C_ l _ ea_e�=�
in �_l k4r-'+- 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. RECEIVE®
Property Owner
ICj_ � �
Print or Type Name
Title
Date
AUG 112021
DCM-MHD CITY
This certification is valid through 2
0.z z 3
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