84582C - Blackmon, Chris

�C.AMA �. DREDGE & FILL$ A B C
Premous permR
GENERAL PERMIT 03Etp tlspurrrilu
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o��`°""+v� LAMA ❑ DREDGE & FILL N° 84582 A B / (.� o
Previous permit
3 GENERAL PERMIT Date previous permit issued
lN ew [I Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized y the State of North Carolina, Department of Environmental Qualityand the
r-Coastal Resources Commission in an area of environmental concern pursuant to:
1 `
I SA NCAC t) I )lX Z) ❑ Rules attached. 1 L General Permit Rules available at the following link: wwwdeq nc gov/CAMArules
Applicant Name '/ Authorized Agent
Adds w(LF Q Project Location (County); (90CW
Address
City Sol FVK V1W State ZIP 7Z674W Street Address/State Road/Lot #(s)
Phone # (_ )
Email Subdivision
City SA), CfZAD )M ZIP .r9)
Affected CW EW FV PTA ES PTS Adj. Wtr. Body 14% Aule'vI L',A��man/unk)
AEC(s): ��y❑OEA PIHA nuW 9SPIMA ❑PWS Closest Maj. Wtr. Body 041 VV (k)
ORWW: yesilp. PNWno
DL_� F 14 �i��l A (??�►S1WGGTy ofPrActivity,. ale:
Shoreline
Length V
Access Length ./
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length 1--�—
Avg distance offshore _
Breakwater/Sill 11�
Max distance/ length /
Basin, channel
Cubic yards
Boat ramp
Beach BUIIQ FC /
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit
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�CoRS(� Ili tT NOS
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I� V A
(� yli bt�G3 ) �� !3 l�IM, V11" '' D LrkYt�
WC. Flo ` -Y-9916
required
-M STAR/PAM/NEUSE/BUFFER(circle one)
v ❑ 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 R VIEWED COrAPLIANCE STATEMENT. (Please lnitial)x ',
\J
Agent or Applicant PRINTED Name P Officer' PRINTED N e
Signature ll -Pread compliance statement on back of permit"
/1 ,il
Application Feels) C ck # oney Order h<flfig D e Ex iration Date

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:
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 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)
http://porta1.ncdenr.org/web/cm/dcm-home
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 Fender Counties)
Revised 6/01/2021

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Q,4.-;s Z
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
re d
to act on my behalf, for the purpose of anplying for and obtaining all CAMA permits
necessary for the following proposed deve. ')ment: '300'd L/f3-
at my property located at /013
in ©'t b Lm tJ County.
uJt eyl'G !�L A4CK �r
1 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 Ow Information:
/ ignaturre /
Print or Type Name
E�� ^A__ '
Title
a I rPg' I�
Date
This certification is valid through S 1 3D I '-�vA
jaOD
RECEIVED
MAR 0 8 ?OZZ
DCM_MHD CITY

�) .3 " : 4 1i
. 96

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTYOWNERNOTIFICATIONIWAIVER FORM
Name of Property Owner: efiy S
Address of Property: &13 C�,gcf/,./i�+� /-� AO- Shaxl- y l
/ (Lot orStreet#, Street or Road, City & County) , / 6Q h Slo u�
Agent's Name #: J�htf �t�c %li/�n-� Mailing Address: //W4P/'lk p�
Agent's phone #: � nS&y &.IZ4 %% C Ryy/�
L., ii
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
the=objections
A description or drawing, with dimensions, must be provided with this letter.
to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athitu://u%r✓uv.!scccastafma!T rsement.net/vseia/r_m/sizffffsfinclorby calling1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse -nr lift mild
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 yner of(AAatio (Ri arian Property Owner Information)
Signature ignature OF CZ
61•t J3L hJor1 C I rig �. /»��l l�l�cl Gi1�lc ,LL
Print or Type Name / � Print or Type N me
1013 4btr,. iw- "?-2!�y A-g 164/h,W
Mailing Address Mailing Address
017/�%
City/State/Zip City/State/Zip
llo 33 0 701C C)�
Telephone Number/Email Address Telephone Number/Email Address
RECEIVED
Date Date
(Revised Aug. 20%R
®CM-iV HU CITY

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: lt9/
(Lot or Street #, Street or Road, City & County)
Agent's Name #: lkkey n-c Mailing Address: n9111111111i ?/ / Wg,C«
Agent's phone 4:110 a15o 'A S✓n d--
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
W � 0 I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available atorby calling 1-888.4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.)
�? 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature — //
<A',fs 13/ALKmci*7
Print or Type Name
/m/3 G4416/
Mailing Address
Sneers l..e.'.-, n �• d�4�Gv
City/State/Zip
Telephone Number/Email Address
Date
(Riparian Property Owner Information)
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Si nature
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Print or Type Name
lI IPioC1 WC
Mailing Address
IJYA5Un WC t SUlF
City/State2ip
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'Telephone Number/Email Address
Date
(Revised Aug. 2014)
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