86579A - Pederson, Robert & Hawk, Jenny

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VCAMA I !DREDGE & FILL �6S%� � C. D
' Previous permit
GENERAL PERMIT z z
Date previous permit issued
UT'New I __] Modificatiork 4&mplete Reissue [ __] Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC — r / ?' a �- - — L � Rules attached. General Permit Rules available at the following link: www.dgq.nc.gov/CAMArules
Applicant Name it 43T. —� --A --J- t
Address JP X:+ . g -A-
City &Lc,A: g State N r ZIP Z_2 S5 Y
Phone # a-U) !V/ y 67 -7 zi
Authorized Ag
ent
Project Location (County):
Street Address/State Road/Lot #(s) / / / 3
7 /ftA S k - ns /2 t.
Email s ---12
' -11 CLC, Q A 4k Y
M 6- t C • s--
Subdivision -'
J
City _^,S k J ;L S ZIP 2_ -7 r% S3
Affected ❑ CW
E P'W
❑ ES PTS
/I
Ac1• Wtr. Body L i9 e�t� 61r�14 Ars ,.cr14�1 Ina unk)
AK(s): IDEA
IHA UW
SPIMA PWS
Closest Maj. Wtr. Body t,� 0 —
,�
ORW: yes Jft
P) NA: yes/to)l
TypeofProject/ Activity �� �e
1n C, t : �
•�-tc.,� C�1 n--r-A S a, `L
�a,.1-47 69/c,
r,-, ��jr A ��r Pi �� (Scale:1,J )
Shoreline Length-. 2—c:) :J
Access Length
Pier (dock) length 1,
Fixed Platform(s) 2
1/ ,,���,
Floating Platform(s) "
Finger pier(s)
Total Platform area 'V5(a
Groin length/M
Bulkhead/ Riprap length
Avg distance offshore _
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp x
Boathouse Boatli f g
Beach Bulldozing �-V [�
other
SAV observed: yes no flQ L
Moratorium: a yes no
Site Photos: es nn� f o J Q('
Riparian Waiver Attached: yes no
,11
A building permit/zoning
gppermit may be required by:
Permit Conditions 4-6-k S `i -1 d 1 •� ,,,
nY�`
P o cK(NG
Exrsnnlc>-
6�.t-►C�tEl�G -�
4-X
r
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 COMPLIANCE STATEMENT. (Please Initial) `
Agent pplicanjPRINTED
. Ct�l - r_ ,
Signaturre **Please read compliance statement on back of permit*•
Appl�icaHo�e� 3Ch� q M1�yOrder
it -e--p A ^-C- C<,-C l
Pe mit Officer's PRINTED Name
Issuing Date Expiration Date

t/.
,P(WN' CAMA ❑ DREDGES FILL
45ENERAL PERMIT
141,4!ew [_] Modification [-]Complete Reissue ❑ Partial Reissue
Previous permit
Date previous permit issued
As authorized by a to of North Carolina, Department of Environmental Quality acid the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC .._— tti `y _—�-.---_ .__ [� Rules attached. `General Permit Rules available at the following link: yr w,Gegn� g4rv1�A,_A11�LuIS3
Applicant Name _ 0 6r��It/t1 . V Authorized Agent _ Y`�Jvff,f�4,t
Address ._ P; r 6_+�1C_ __ Project Location (County]: t
City �y 4� a State _......... _ C ZIP �7 Street Address/State Road/Lot N(s)
Phone # (pg-) Y1.._1./
Entail ._td6t c zela t r e e s? y .� 0 s e o Subdivtsiort . )
....� J city As11 6 a S ._� _ ZIP Z% 9 5 3
Affected CW ,EW ATA u ES � PTS
AEC(s): OEA INA uW SPFMA PWS
OW yes PNA: ye no
Adj. Wtr. Body _....._AlQ, _t j � - . !_1A.A . .......................��k)
Closest Mai. Wtr. Body
Type of Project/ Activity C! c � .+ (�
(74- - "-a I t f o .. s Z qf X/ Y f
LL / Pita 4-4Z t--- l Co r (s �_! o .a ,+9 r p i (ate / )C (o r JO i t-r (Scale:
Shoreline length 4 7-0 o ,
Access Lenglh __ �__�
Pier (dock) length 4b l� r0 Yj'C�
/ Qd (�L u idir.
_
�,
FixedPlatform(s)
Floating Platform(s) = /
Finger pler(s)
Total Platform areaiD
Kett C
9�
_
Groin length/ff
ja
YY
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boathouse tkft ..JJ,C 1_ y s�C-d_ y14
Y
Beach Bulldozing---------_- `✓ y �' E ¢ r S f /n16 Al r,.z..1�F{D
W
Other _ y
`�
y Jr lea / 2, 6 9 if t. e.eA4'e.Ceci y
SAv observed yes t 0 M-C
Moratorium. n a s o F i
< 6��
A f L
n
Site Photos: lye no
Riparian Waiver Attached: yes no i3 a0 f
jj
A building permit/zoning permit may be required by: _Zb_- ..r. ....... ``.!� `( ___. __._ ._..__.._
1 r ! � 4, TAWPAM/NEUSE/BUFPER (circle ate)
Permit Conditions __ _/�L^^ � !►. 0. G [
See note on back regarding River Basin rules
See additional notes/conditions on back
I
Brandon Mitchell
Agent or Applicant PRINTEDDyName
12/29/2021
Stg ture "Please read compliance statement on back of permit
2
Appa fl 33
iieatkm Fe (s) Check 9/money Order
10 RE`4/IEWED COMPLIANCE STATEMENT.a friease Initial)
j ✓?
per —1-tmtt`Officer's PRINTED Name
Issuing Date Expiration Date

I
AGES NT, At T T �,•.� rnu f'A%q APPt=i A�?�N
Narne of Property pwner Requesting Permit: !
Mailing Address: -� o
---
Phone Number: 414- -oQ 3 0.
Q �,(� Qrn�yCoM
Email Address:
Certify that I nave authorized _ Agent r Contractor
obtaining all CAMA permits
to act on my behalf, for the purpose at applying for and �`.
necessary for the following proposed development:
r o o -� tvt. 2103
at my property located at _15UTICI M �0e!-,..,
in County.
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
staff, the Local Permit officer and their agents to enter
Divrsion of Coastal Management
ection with evaluating information related to this
on the aforementioned lands in conn
permit application.
Property owner Information:
rbIlLYf
i
Signature
Robert Pedersen
Print or Type Name
_C.'Ay!Otc-
Title
10/22/2021
Dale
This certification is valid through ----J

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U Complete items 1, 2, and 3.
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■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Addressed to:
r-N(c...n
2'i frog
[1r" ILIil�'ll'111!II I!I II I II IIIII III
9530 9402 6011 0069 6533 66
I 2. Article Number frnm cRnf"' 1Ah%4l
?020 3P60 0001 5279
PS Form 3811, July 2015 PSN 7530-02-000-9053
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A, Sign
x
0 Addressee
—15
R ivicee ivicee ed by (Printed Name).C. Date of Delivery
.?l —
e-14 i �& & -%I I ?—It I A-,
D. Is delivery address different from item'17 Q Yes
If YES, enter delivery address below. 11 No
3. Service Type
❑ Adult Signature
0 Adult Signature Restricted Delivery
❑ Certified Matt®
❑ Certified Mail Restricted Delivery
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
8140 �l Restricted Delivery
it
D Priority Mai? EaTressCg
0 Registered 14iai1Tpt
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Dec�lstered Mail Restrictedt
Dlivery
Q Return Receipt for
Merchandise
El Signature ConfirmationTm
0 Signature Confirmation
Restricted Delivery
Domestic Return Receipt ;

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Tracking Number: 70203160000152798010
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Your item was delivered to an individual at the address at 1:24 pm on November 20, 2021 in
MANNS HARBOR, NC 27953.
G Delivered, Left with Individual
November 20, 2021 at 1:24 pm
MANNS HARBOR, NC 27953 -
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Tracking History
November 20, 2021, 1:24 pm
Delivered, Left with Individual
MANNS HARBOR, NC 27953
Your item was delivered to an individual at the address at 1:24 pm on November 20, 2021 in MANNS
HARBOR, NC 27953.
November 20, 2021, 4:59 am
Departed USPS Regional Facility
ROCKY MOUNT NC DISTRIBUTION CENTER
November 19, 2021, 11:16 am
Arrived at USPS Regional Facility
l of 2 --.=- 12/22/2021, 10:59 AM

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Tracking Number: 9590940260110069653441
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Your item departed our USPS facility in ROCKY MOUNT NC DISTRIBUTION CENTER on
November 23, 2021 at 5:02 am. The item is currently in transit to the destination.
Departed USPS Regional Facility
November 23, 2021 at 5:02 am
ROCKY MOUNT NC DISTRIBUTION CENTER -
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November 23, 2021, 5:02 am
Departed USPS Regional Facility
ROCKY MOUNT NC DISTRIBUTION CENTER
Your item departed our USPS facility in ROCKY MOUNT NC DISTRIBUTION CENTER on November 23,
2021 at 5:02 am. The item is currently in transit to the destination.
November 21, 2021, 11:29 am
Arrived at USPS Regional Facility
ROCKY MOUNT NC DISTRIBUTION CENTER
1 of 2 12/2212021, 11:00 AM

I
1
1
1
UN1�E ST/1TES
POSTAL SER VICE.
KILL DEVIL HILLS
302 S CROATAN HWY
KILL DEVIL HILLS, NC 27948-9998
[phone]
11/18/2021
------
12:30 PM
------
Product 0ty Unit
---
Price
Price
-- - ---------------
First-Class Maiie 1
$0.58
Letter
Manns Harbor, NC 27953
Weight: 0 lb 0.60 oz
Estimated Oeiivery Date
Mon 11'22%2021
Certified Mailf
$3.75
Tracking N:
70203160000152798010
Return Receipt
$3.05
Tracking N:
9590 9402 6011 0069 6534
41
Total
$7,38
Grand Total: $7.38
Debit Card Remitted $7.38
Card Name: VISA
Account N: XXXXXXXXXXXX5243
Approval N: 070946
Transaction N: 915
Receipt N: 032793
Debit Card Purchase: $7.38
AID: AOOCCO00980840 Chip
AL: US DEBIT
PIN: Verified
Man8-v Harbor .
PC
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rMs map n ptepued
9mOwrers: reCersen, Robert C -Primary Tax Distract; Mashaes
dau�,=d rotth. S679 Mashoes RD
{ ?!. �.Mwyau <•�a Mashoes NC, 27953 Owner Subdivision: Subdivision - None ")
✓� p O ' `° Parcel: 017460001 Hawk Jenny R -Primary Owner Lot BLK Sec. Lot: Bilk-, Sec.
R Ot`4!S Dram ary
t m,:untourtnsac� Pin: 964106482014 Building Value: SO Property Use: Secondary Improvement <� ,
otMa dxdt. pits. Land Value: 1205.400 Building Type: y„>_
�" II ana utter p+tmary
Misc Value: $20.600 Year Built � �>
.utrrdi« odt<a•oo Total Value S226.000
t the �to,•en..,•+
_ancxr,.d ft. map.