Dudley, Alton 77088C

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AMA / ❑ DREDGE & FILL N9 77088 A B (C J D
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue '-]Partial Reissue Date previous permit issued/ , ^
ed by the State of North Carolina, DT.partment of Environmental Quality
and the Coastal Resources Commission inan area of environmental concern pursuant to 15A NCAC /r•�' 6/� / %-/ /' L
^ t pRuleAattaChed.
Applicant ame Project Location: County
Add4#WE-Mall
Stree Adddrreess/) State Road/ Lot #(s)
CityState ZIP �3 / ULA� A) I -pow
PhoSubdivisipp A Q 1
City ZIP &A UIR1111111W
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Closest Maj. Wtr. Body .111YWIN
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MEN
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cubic yards HIS
Boat ramp '
Boathouse/ Boadift
Beach Bulldozing
Other �u-q'
I t 7!. r oil
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Shoreline Length L
SAV: not sum Y.�� '!I! ::�::�'SiTniTiii I� oni
Moratorium: n/a yes
Photos: yes61tL
Waiver Attache�ddv'y"�� e�s
A building permit' 'ma$%re ud y:ire_
( Note Local Planning jurisdiction _ n,
,[Dotes/ Special Conditions i l w
or Applicant Prints Name
S, ature Please read compliance statement on 'Tr6";,
Application Fee(s) CheckW —7
See note on back regarding River Basin rules.
00
Signature
10115) � i►sl2�al
Issuing Date v 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 I) 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, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar -Pamlico River Basin Buffer Rules ❑
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's BufferRules 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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
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)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(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 Pander 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: aw" t—�Li)
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
�123 O'P�
/��
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:�-y--
at my property located at
in County.
I 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.
Property Owner Information:
`xkD&q V3 -In"JhZ
SignaturEj
C`�d�16rVh& t" A'�rl
Print 6r Type Name
C -lkj -
Title
! 0 ! -L /7Zt?
Date
This certification is valid through

ADJACENT RIPARIAN PROPERTY OWNERSTATEMENT
I hereby certify that I own property adjacent to r n1's
(1ne of PrQ er Owner)
property located at %��% )aE7 rno,a.� lIS 1-0)1%4- ILO1
�p (Address, L Block, Road, etc.)
on, C o/l '� w `:k' /L . in �'e, � N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
169
tion.
I have no objection to this proposal.
a. T - &77016901901010 _
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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WAIVER SECTION
I 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
ture
Print or Type Name
Telephone Number
Date
Date
0 2. 2 a
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � ISc�
' . (Na a of Prq�rly Own r)
property located at -J7 V 1 a1
(Address, Lot, lock, Road, etc.
on �-t� �L lulzm rL..a, in N.C.
(W y) (C' own and/or County)
e applicant has described to me, as shown below, the development proposed at the above
to tion.
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)
, I /6y 1- ----0 . A7r(jir5s
S/ O Y
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ovn t3x�
ezy
lbov io , 2
FW
y �1*' k
WAIVER SECTION
I understand th_at 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.)
C V-- I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback requirement.
(Property Owner Information) (Adjacent
c-4- /)
Date
0
rnnr or i ype rvame
��� W ti �x IIf Pl, to
Maij" g Address
ISsA✓4i llr.�5/6
City lfof'
Telephone Number
Date
(Revised 6/l a2012)