Box, Jerry 76366C

LAMA DREDGE a FILL No. 76366 A B O
I\"ENERAL PERMIT PrrNatspwtr*#
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❑DREDGE & FILL No. 76366
—. A B /10 D
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued
As authorized by the State of Norch Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /
Clio G
Rules attac ed.
Applicant Na a Project Location: County AIWA
Address �j Street Addrre'ss/ tate Road/ Lo #(s)
City State ZIP l/ O V �/�M a
Phone # f7 ail Subdivision
Authorized Agent
Affected Li CW 'f'EW PTA ES ClPTS
AEC(s): a OEA ❑ HHF ❑ IH UBA ❑ N/A
❑ PWs:
ORW: yes / U PNA
Type of Project/ Activity _
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length `—
avg distance offshore�—
max distance offshore
Basin, channel
cubic Yards �---^
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing�� J C t,
Other Nofi='Pwtr'1- A3t
Shoreline Length Ill\ ✓✓
SAV: not sure yes
Moratorium: n/a yes no)
Photos: yes no
Waiver Attached: no
A building permit may be required by:
( Note Local Planning jurisdiction),
no
Phone #
Adj. Wtr. Body t
Closest Maj. Wtr.
rF
(Scale:I�� )
❑ See note on back regarding River Basin rules.
statement

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
nul I 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, certifythatthis project is consistentwith 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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/1-888-41RCOAST
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 Pender Counties)
http://portal. ncden r. org/web/cm/dcm-home
Revised 7/06/I7

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: J EInzy 'Foy
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Z226 NWy -Z /
,A)(WO/6 Svc 2$S-70
Z.Sz 261- 7f,6z
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Agent
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
57 X so �o�i� P,041Wy
/D Ix /o % „ �L•��% °/LH ; ( Z) %� ,-, aFF
�Z Jyc-c%ooer N�
at my property located at Z8 /,yW� 2� ,
in 6MreYk41� 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:
Signature
ecX
Tint or Type Name
!��✓NFI2
Title
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to fflity ►3oX s
(Name of Property Owner)
property Dated at 2zzg pwy Zy
(Address, Lot, Block, Road, etc.) N.C.
on &Atoms 5 C-9C-&K in N6 10 )
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
6`�41- 1 have objections to this proposal.
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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 must initial the appropriate blank below.)
p Pit I do wish to waive the 15' setback requirement
I do not wish to waive the 16 setback requirement.
►pmrwirty Owner information) (Adjacent property Owner Information)
w
c.rryialWWup
Telephone Number/email address
Date
-valid for one calendar year after signature'
4 /(ram.(✓
Signature
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Print or Type Name
a�L RyiZGN .�/l/Dd�s �'oPD
Mailing Address ci.NG eLZ.7 o/ 7
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city/statemp
Telephone Number/email address
33C- CV- 73CI
(Revised Aug. 2014)