Thomas, James 84366C

oN°Ft°"S'"( AMA ❑ DREDGE & FILL N9 84366 A CC
D
E N E RAL PERMIT Previous permit
y � Date previous permit issued
ew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized b t State of North C ro/a, e artment of Environmental uali and the C astal Resources Commission in an area of environmental concern pursuant to:
15A NCAC y r ,� �/ P ❑ Rules attached. General Permit Ryl,s available at the foll� j ing link: www.deq.nc.gov/CAMArules
Applicant
Authorized Agent
Project Location (County):
Street Address/State Road/
Sub(
City
Affected ❑ CW EW TA ❑ ES ❑ PTS Adj. Wtr. Body (n an u )
AEC(s): OEA IHA ❑ uW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/(f)
PNA: yes/ o
Type of Project/ Activity.
r
Shoreline Length S
Access Length
Pier (dock) length`
Fixed Platforms)
Floating Platform(s)
Finger pier(FT— ----
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore s
Breakwater/Eiji
Max distance/ length
Basin, channel'-----
Cubic yards
Boat ramp
S
Boathouse/ tlift
Beach Bul doz i
Other
666
SAV observed: yes
Moratorium: n/a yes no
Site Photos: o
Riparian Waiver Attached: � no
A building permit/zoning permit may be
Permit Conditions Ili\Y o I k'
(Scale:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
ElSee 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:
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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: rn -c C -T i M f15
Mailing Address:
Phone Number:
Email Address:
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I certify that I have authorized 01 U Q /:�>L,-ck cp- F my <
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: &!% ) A Do c k-
L i�-T
at my property located at 1 2'e G/-- J v
in e�� Y2-4 -1 County.
I furthermore certify that / 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:
b k«'-6--
Signature
rv\e
Print or Type Name
Title
Date
This certification is valid through I /
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DEC 15 2021
DCM-MHD CITY

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)WNER STATEMENT
I hereby certify that I own property adjacent to
property located at /
tAQUMSs,
on IL'r" �;.:� i L 11 in
4Waterbody)
(Name of/Property Owner)
H
,ck, Rgad, etc.)
(City/Town and/or County)
I
N.C.
The applicant has described to me, as shown below, the development proposed at the above
locati �
s
I have no objection to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
6 CJL
I understand that a pier, dock, mooring pilings, b eakwater, 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 #ropriate blank below.)
I do wish to waive the 15' setback requirement.
_ I do not wish to waive the 15' setba�k requirement.
I
(Property Owner Information)
-A- E ��
Si attire _
Print or Ty e Na
i Z , r(- 7-,�2
M gc. Add
i s (�� (�
4 1
City/StatelZip
( 3 a
Telephone Number
_ Cf116 72)-7-
!
Date
(Adjacent Property Owner Information)
SiTature
Print or Ty7 Name
Mailing _ Address
City/State/ip
Telephone Number
s'a - 9a 5 /-/y l(e, RECE WEE.
Date
(Revised 6� oJA 2021.
0CM-MHD CITY

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11 /19/21, 11:59 AM
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ADJACENT RIPARIAN PoQfZnn STATEMENT
I hereby certify that i own property adjawnt to Aj-K
' (Name of Pr party Owner)
property located at C UJIZ2 211.-
jAddress, Lot '0* aftc.)
r
on e- C1 in
Materbody) (CHWown andfor County)
The applicant has described to me, as shown below, the dejeJopment proposed at the above
to ti
I have no objection to this proposaL
DESCRIPTION ANDIOR DRAWING OF.PRCOOSED DEVELOPMENT
(Individual proposing OrmkpnjOWMtASf ffif to Sft
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