85709D - Harris

J ICAMA ❑ DREDGE & FILL N° 85709 A B C D
a Previous permit
1 GENERAL PERMIT
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized Eby the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
oL'
15A NCAC t J ❑ Rules attached. General Permit Rules available at the following link: www.deq.nc.Yov/CAMArules
Applicant Name ` c� 5 Authorized Agent
ApP
Address `; �� ^ u k. h t yl \Z Project Location (County): \J I —I c
City 117, State L, ZIP Z�Z Street Address/State Road/Lot #(s)
Phone # ( L1i .t u-- rl l1
Email ,, N . n , : U • (� ^ Subdivision
City (.' C. c. 1 S < < c ZIP
Affected ❑ CW 0 EW ❑x PTA ❑ ES ❑ PTS Adj. Wtr. Body i. ^ , f� (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑JuW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 1 w wr
ORW: yes/no PNA: yes/rsol
Type of Project/ Activity < ti V?o:A,
ji .0 (Scale:tJTS )
Shoreline Length ; i) u/
Access Length2—
Pier (dock) length L+ Kj2
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift-
Beach Bulldozirig
Other
SAV observed: yes na
Moratorium: n/a yes eo'
Site Photos: yes
Riparian Waiver Attached: `yes/-�4,1t6�
A building permit/zoning permit rriSy be required by:
Permit Conditions _
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Off1t s PRINTEQ Name "
Signature **Please read compliance statement on back of permit** Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency - A
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: 5"Aannoe. No-jrr. S
Mailing Address:
Phone Number:
Email Address:
15 3 3 S4V- e,4 (fr
NG a 7X 1
334 a6 3 - ta-7q
r,
C o PV%
I certify that I have authorized W'v� 4\— ,
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,I )_0 0
at my property located at oC L G'n ce r ej ')I . � U C if
inrcnSWic County.
I furthermore certify that l 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
Sha h h o•, 146r I', S _
Print or Type Name
Title
Date
This certification is valid through / /

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Shan n on �(A,rrW, 5
Mailing Address: ( 5 3 3 56ft a, Leer 01,4w
n i N C a 7 a
Phone Number: 33(, .2- 6 3— I a 74
Email Address: k& rVr, s . Si &k. n. o" L u a.ho o , Co
I certify that I have authorized )?C4o_hc4 `�k—
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: )u 22 )"i"IQ
at my property located at .Z Co n t o f), S 4
in Sw I'G L County.
RZ
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:
Signature
an 1-42rr, 5
Print or Type Name
Title
/S / .20a!
Date
This certification is valid through /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Shan non /&W -" 5 's
r, (Na a of Property Owner)
property located at _ a �� r, r� 7
/+ (Address, Lot, Block, Road, etc.)
on _ C, Q hG4. I , in ©G a, l-P Gt �� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
Z,1VII, el 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, 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.
(Prope Owner Information)
c
Signature
Print or Type Name
/S 3 3 S n I!" C'r P�� Clwr•r,� l�-
kifi.')
ng A Jdres
A/ a 7.2 1
City/StatelZ
334, 21,3 -197g
Telephone Numper
Date
(Adjacent Property Owner Information)
ign tur
706 S11A,,-
Print or Type Name
LY cin cor-W ISV .
Mailing s
Addre
��.>oov. Ts7� 13eQ� , A/ a841� 9
City/State2ip
F/0 988 - (� !� 7 7
Telephone Number
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Sh 0. ri n a e) ha r r I S I
(Name of Property Owner)
property located at a C o n C v r
//�� (Address, Lot, Block Ro d, etc.)
on l Q Yt Cc. , in t^�GQA-rl. fS 3e" , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
QUA'— / 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, 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.
(Prope caner Information) (Adjacent Property caner Information)
aLu
Signature 11 _ Signature /
S�1Llnnon i�Q,✓/.S P>°Ue-
Print or Type Name Print or Type Nam
L533 n.e4 C{e .L It G 3 4L'n UW
Mailing Vdress I Mailing Addres
IV al A/C 7s1S
City/State/Zi City/State2i
336 aG 3-12-7y 3.34 585-6911
Telephone Number Telephone Number
Z-0 4a Aorz -1 /&A -a- /"-2-
Date / Date
(Revised 611812012)

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