Sanderson, June 84849C

oo-W4 AMA ❑ DREDGE & FILL N984849 A C."IP
Previous permit
1 GENERAL PERMIT Date previous permit issued
ew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As author' ed by the State of No V olirta, Depart pf Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC �J ❑ Rules attached. eneral Permit Rules available at the following link: wwwde�nc eov/CAMArules
r
Applicant Name L, -(A--e Jij�'-✓t 0'11�
Authorized Agent
Address ���- - t VL / Ali f�
Project Location (County):
Ciry [ 1✓ c"'"� o'� St to ZIP
Su eet Ad ress/State Road/Lot # s
( )
�''��
Phone #)
Email
Subdivision
_A
City CU i !U
ZIP tJ
Affected --';;f�PTA ' ES ❑ PTS
Adj. Wtr. Body �'
r f
na' man/unk)
��
AEC(s):❑- OEA ❑ IHA ❑ UW ❑ SPIMA
❑ PWS
Closest Maj. Wtr. Body
�✓)
ORW: yes/no PNA: yes/no
Type of Project/ Activity t� J cti
`2
�, e> C' +—
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(Xs) rr^
Floatin'Platfo m(s)'
Finger pier(s)
Total Platform area
)JCe'
aBulkheadprap length
offshore
Breakwater/Sill
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp
Beach Bul
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zonipg I
L,IU -i�,-
(ScalWTP
❑ 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.CQMPLIANCE SyftMENT. (Please Initial) JR
t� Aannoa" G©cr»r a n
Agent or Applicant PRINTED Name Permit O ce s PRINT
OU VVOAL Q
Signa re *Please read compliance statement on back of permit** Signatur
Ap ' ati Fee( Check Money order Issuing Da.I Expiration D to

'�OF COASTq/ y9 AMA ❑ DREDGE & FILL N9 84849 A B c
,G E N E RAL PERMIT Previous permit
y Date previous permit issued
ew [—]Modification ❑ Complete Reissue ❑ Partial Reissue
As author' ed by the State of No Carolina, Depart maen�t,pf Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. �eneral Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City
Phone #
Email
51
l►.11i
Authorized Agent Y " J/
Project Location (County): tV %"
Street Iress/State Road/Lot #(s)
12 G1'01-f d v.
Subdivision
Cityj/t0 N ZIP
Affected A ES ❑ PTS Adj. Wtr. Body na man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
KL2rl i (Scale;A
Shoreline Length
', a
Access Length c ( a/ /Lel OVPier (dock) length ei "`/ �(((/// �ir� /
Fixed Platform(s) {j�l �/
Floating Platform(s) l
Finger pier(s)
Total Platform area
=.Ikhead/cRprop length
offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/liroatlift
Beach Bull
Other
SAV observed: yes RY
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes n
A building permit/zoni perrrlit may)w required
P Condi
ri d rl/c/k P�^s'
✓/e7-c✓%
I AM AWARE OF STATUTES. CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED
Agent or Applicant PRINTED Name
Signa re *Please read compliance statement on back of permit"
ApjWatiVFee(y Check # Money Order
Permit
Issuing
�
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
PLIANCE SYATfIVIENT. (Please Initial) •
T
Expiration D,te

Statement of Compliance and Consistency
3
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

Name of Property Owner Requesting Permit:
Mailing Address: �22 Leh �a�� Mahe
i
Phone Number: O 2 - \'D
Email Address:
ic�eve cor�ro,c, �r,g Nc
I certify that l have authorized Dia k or •1Gto�1 coast NlO\ n n e Cory'j a&h c1 ,
': N AY\Yna M GochYarfgent / Contractor J %A s t--iv,� G��V
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development- 12-5L v iL,�_ ayi 1 K`n qG�
at my property located at �22 L\he zooa-V Lome ,
in o nS 10 W County.
i furthermore certify that i am authorized to grant, and - do in fact, grant permission to
Division of Coastal Management staff, the Locat Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property
Signature -
C-i, tt C'
Print or Type Name
Due
0'�' , _z I , --�4
Date
Tnis certrncation is valid through I t

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that i own property adjacent to 1"n e sca r,de IrS ©r 's
(Name of Property Owner)
property located at
L-G " e-
(Address, Lot, Block, Road, etc.)
on "h0re. WK I , in SwanS _nyo /Qn 1 Q7 L[ , N.C.
(Waterbody) (City/Town ardlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
L✓-' I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR, DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16 from my area of riparian access unless waived by
me. (if you wish to waive the setback, you m itiai:the appropriate blank below.)
r I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
/ (Proper"ner Information)
S ature
,1 W�jQ sa rc�d Q rs c� Kl
Print or Type Name
122 Lint ?-,OQ4 LO rn t
Mailing Address
wcG 2g,5iN
Ci4,lState2ip
2-S 2. - LAC) 2 - �o do \o to
Telephone Number/email address
Date
Walid for one calendar year after signature*
(Adjacent Property Owner Information)
ature*
t=rcar,ctS o�- UJ-C� c V9 't ISC)"
Print or Type Name
k2-LA i.-i nQ. i t L,0 nE'.
Mailing Address
C b&Wa1&0p
Telephone Numberlemail address
Date*
(Revised Aug. 2014)

�:L�wL•L�i, r
I hereby c ei* tE>ai { own prnpertj ac
- property tocabed et _ 122 l.i n P.
(WaUrbody)
The nt has described to ma
i have no objection to
I have ob*Wns to th
Ato June. jS
(Name of Pros" OWM4
U. LA B10* Road. atG.j
In Arun n5 horc� or%51 t'yV N.C.
(CItyfrown andlor County)
shown below, the development proposed at the above
Ws proposal.
5 pmposaL
DESCRIPTION ANDIOI DRAWING OF PROPOSED DEVELOPMENT
lhiifhrldtrai p �liosf�ig de5ielopmerrt Hurst M fn desc*tton below orattach a site a"winO
_ f
e j r t
WAn" SECTION
I understand that a pier, dodS mocripq pfts, boat ramp. breakwater, boathouse. 0, or groin
must be set back a minimum ftmrw a of 16'from my area of r ur�sss watered by
me. (if you wish to waive the sett dk , you must Intif0the op bile - - beto
do wish to waive the 15' se3�k �
o not wish, to waive the 16 setback regWrmner t
,. {-•�pe`4 �1,0yvnerlrriormatioa} _ (AdJattutt a erin rrrratton}
r
_r
:••ems► • a t+��
"Vagd for one calendar year eiterIsignoWW
Scanned with CamScanner

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