Clark, Edwin 88703C

�oEtoasr4z ❑LAMA ❑ DREDGE & FILL NO 88703 A B C D
0
y = GENERAL PERMIT Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete 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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale;
Shoreline Length
Access Length
Pier (dock) length
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 Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be re
Permit Conditions
` _ �! ✓' ❑ See note on back regarding River Basin rules
.� 1,
❑ 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 or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit** 7q Signature
Application Feels) Check #/Money Order Issuing Date Expiration 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:
F1Tar - 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

,1*jWA""1 T❑CAMA ❑ DREDGE & FILL N9 88703 A B C D
y��
3 Previous GENERAL PERMIT p
y � Date previous
permit issued
❑ New ❑ Modification ❑ Complete 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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP.
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier(dock)length
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 Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be requiieu uy:
Permit Conditions
(Scale: )
❑ 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 or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit** Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration 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:
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 wCAMA P!=RMI ,I ION
Name of Property Owner Requesbng Per rnit.
Mailing Address-
"s ") 4
Phone Number, � ... _--_ - -A-.__
Email Address:
F--
I certify that I have authorized
Agent t Contractor
to act on my behalf, for the purpose of applying for and (obtaining all CDAMA permits
d3
necest: � s ar
g
at :may property located at
1 furthermore certify that a'7 io cf'c nt, and JQ !I- r act grant pert issi n t
Division of C'oast:--ai Management staff the ! oCal Permit Offs; --mr and the ir agents to enter
or, the a-ib1°eme77I`ioned lands in t',ol7rject,,on with evaluating in? rt-n.atio i re/at d to this.
x:.eri77it �:aT, 11COtiOra-
Property Owner information,
tji(µs
r Print
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
CER_T_I.F_IED_ViAll RETURN RECEIPT REC�UESTED or-HAND-DELIVE-R-Y
(Top portion to be completed by owner or their agent)
Name of Property Owner
Address of Property:
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i
Mailing Address of Owner 3
.4-;W,17S /�P
Owner's email-, (144P t,(/1.Owner`s Phone#. -
Agent's Name-, Agent Phone#;.
Agent's Email__ -PAA e-'tolA
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
I ,Bottorn 2ortion to be qom.gp!1peted by the Adjacent Property Owner)
I hereby Certify that I own properly adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown or, the attached drawing, the development they are proposing. A
Al DO NOT have objections to this Proposal, I DO have objections to this proposal
If you have objections to what is being proposed, you must notify the N.C. .1. Division .. . of CoastalI
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail,
WAIVER SECTION
t understand the' any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' Born my area of riparian access unless waived by me
(this does not apply to bulkheads or ripraP revetments). (if you wish to waive the setback, you Must qig
the appropriate blank below.)
I DO wish to waive sorne/all of the 15'1s.Ptbac.%
-OR- Signature of Adjacent Riparian Property oWnOr
I do not wish to waive the 16 setback requirementlinitiall the blank}
Signature of Adiacent Riparian Property Own F:
Typed/Printed name of ARPC:
Mailing Address of ARPO: 5+,
AAC, 60 r_to
ARPO's email �C�;+ ARPO's Phone#:
Date: --waiver is valid for up to one year from ARPO's Signature'
,Revised July 2021

AGENT AUTHORIZE 'rION FOR CAM A PERMIT' APPLICATION
Name of Property Owner ;Qequesting Permi-
Mailing Address: Wo
Phone Number:
EFTIC�il Address-,
I certify that I have aUthonzed
Azew i Contr�,+ictcx
to act on my behalf, foctthe purpose of appl%,dno. for and obtaining all CCAMA permits
n1-cessary for the following prc)posed 1'-velom pent: %
r"A
at IT'ly properly located at k Q
....................
in A"J07�tg4�,-r- cou
fur7`hem7ore, certify that atzi £julfhonzecf to grant, and do in �ict grant permission to
Division of kGoast al Manaaennent saff, the Local Penmit Of'."icer and their agents to enter
on the atremei-ftioried i'aoals in connection vvith evajuatir'lsg information related to this
Permit R� Pficatlofl'
Property Ow'ner Information:
Signi,101re
P�rtntor T-ypo Ahirr-t',
h �s csrfllicaflcx ;

01"I" (DR COASTAL MANAGEMENT
AUJAGENT RIPARIAN P1cg�)�,
CERTIF)EiD MAV RETUat ir-%Itf I-ANNER FORM
(T,,)p Portion t.c,
"Vk A
None of PMPWY Owner
Addre,,z� ",If Property, i
MWM9 AdAms of
J,
_8�Qg
j
Agens lsriq_
ADJACENT PROPERTvl 01tiNER'S
J�""he P'qt�qen�
hereijy cf.�rtify
00w ills deS7TWnceci pr,)pej,;,�,
cribed to 1'h0irdfvidLi fapplying
for this
thoy aj,c-, pmposing, 6�
or d,
fDO m c;,r
lF You h9vo objectiors it: jr 1, 1 DO ")vto 1hisproposal.
you musi nodfy t'he Mc, Coastal
3t7 vTJV71!�i' wif,17in '10 d,?�IZF of
v , , OiPt Of Zhis !70dce. Conespondence should be
-co Ah"o., 1�'Horeh'e'ad ci�*,'. Pic 28657.
mailed to 400 compl*� re_ c DCiVl '_QPNs0()tafiv0s can 0150 be contacted
at (1?647) 808- 2808. No respon,CR ;s rn, r?_,4derse
;d Moil. Coilffir C_ "3' " r1c) 04ic'ct"01) ifYOU have bepn notified by
-'.jnderqt-,!j-j0 thwany PrOPOelll peri �' , ,
p. 00�11 iclriV, b ath li maF ft, or
OW MUA be so bk �L'j i'oinii-,iium
(ME "ims W WY io bulkhead'�;,ir unlf�ss 'Walved by me
r, "ilf'YOU Whh to waWe to somack you UUM11W
18 appmpnwc bwnk below "—1i
100 Wish tko
1 do not w w h p wgwe
of :,Rpo:
,lit'9 Of ARPO: 4_�
ARNIPO'�s ornjiq:
Date: IAO!o!iiit7n, Yeli firon, ARPO,s 'Sic
P (4 Wis ­ d J t il,­ 202 -il

N., DIVISION OF GX)ASTAL MANAGEMENT
ADJACENT RIPARIAN PR,0PERP1'0WNER NOTIFICATIONIWAIVERFOR
C BI[FI MAIL ;UN RQSRt��TEor F�DELIVERY
L
Jop portionto be co:mole.ted by ,Arne,- or their agent)
Name of property Owner, �� ` 6 a r
Address of Rropert,,
Mailing Address of Ov/ner.
Own r' earnail:
z CI .
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
[hereby e ert€r'/ khat I own p€ operW eadpat ..° tO �1 e ::lane referenced p operty. Chu ,rdiv€dual applying for this
perrnit ii as ctescrihed,; tQ ;ne1 as shown .r' the ,^itic`is:,ned draw0g, the r1levelopment they are proposing. A
qgq( i 1t4QP°i QC drg i0 k j, F.�It`jq Q sit€Ist ? rirtl d t€ t a I itt r. __ ). _, _ _ __.
I D)I lv > ot),lections to °1i" I DO have objections to this pr-posai,
If you, have objections to what is being i op o ard you rra.rst notiflI� the . ,C, Divisican of oastal
Management ( M) in writing within 1p days of receipt of this notice. Correspondence shouldbe
mailed to 400 Commerce Ave.. Morehead City,NC 28557, DCM representatives can also be contacted
at (2 2) 808-2808, PJo response is considered the standee as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
J S
I i.1rldQr iat?d that any rC: t;ise? n7 L r, w''G- it ,C t <a .;IiF s, -,o at ramp. i7!Q78CLI tL C: tJ c�:I riu tx, I ft, QC
arc€rr € €?Ut be set a aiii€ t€ri rt t }i_kr € ., € t_3 $ i :-i4f` &A s fi E €? , rGrtrgunlesswaived €i kU by rile
(this does not apply to bi.=kh-lads or rIpr,c-p rt:vet t% cad:";J aEr etbcdC i<, ;rot, TIa t si
gp
the appropriate diary bolo .p
Anet
r
-OR-
i do not ,,41. r. €.i,.; ';Naive the IJ' setback N.,qL,, eni i"€' (d.. i€trial ffie 0I,,,,3nk)
grla ire o. , t l acent Riparian P rop,er v Owner
TypedlPrinted name of ARPO-,
Malting Address of
A O°s --mail: e..._�., .�. _...�__..._. ARPO's Phone#.
Date: Waiver is Valld for up to one year from A€ PO'sSignature'

AGENT AUTHORIZATION FOR CANIA PERMIT APPLICATION
Narre o Property Owner Requesting 1__Ierrnj,
Mailing Address:
Ernail Address:
d r
l certify that i have authorized�,�,,,. e o r' �
Agent Contractor
to act on my behalf, for he purpose of :applying for and; obtaining all CAMA permit -,-
necessary for a e foJlowj,, "fi pro,,F'wised d ev lc-,orn . W: ,
m , r {gyp a �3 t ` �
:�i € i i� property !�' i+„34✓C"��ix.�.� ��l ,.,..,d.. �_..._, � ��4 �
r
in
1 furthermore cedify tf i ? aln author.,-1 ind do in fact grant permission to
Division QI L 3 t i Management staff. t?r i7 `i3 Ir c3C7'l i` to enter
an the a, brert7entif3J',ed 'c9nds it? ^C3nn—, ;1=.:"? _ ,.iJua,iti inirorn a i n related to this
permit application.
Property Owner Ig or r t ti .
, �sS,r
J,
rl i i i f F4') :r F r j�, %
»m-+. ...-�... ,.•x...«.,<„ n».,w ""��...+.w ,., ..a.a...--,van..,,.,..w.w.«am«aww-..,a«..
Signature
s
_e
<.,•m
IQ ,sir[ err f elf?} P
6 n
ir
.... ....a ......_.. __ �. ...................._... _,_

N.C.DIVISION OfCOASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIF)CATIONfWAIVER FORM
(Top portion to be completed by owner or their agent)
Name of Property Owner
Address of Property-,
Mailing Address of Owner
i\'(�`- / /'/ '
vu``�mr` �' `-�c/v-
' '
Agent's Name --
Agent Phannet,',_
Agent's Email— �5hvlf r
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
'Bottom nortion to be com
Ihenabyoertify that iown property adjacent \othe above referenced property. The individual applying fon1his
permi!hsn described to me, as shown on the attached drawing, the development they are proposing.A
|DO NOT have objections to this proposai,__|DOhave objections 'to this proposal,
If you have 6_b_jecti&n_s to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice, Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mai),
WA
IVER SECTION
SECThON
! underotandtha\any proposed pis, dock, mooring pilings, boat ramp, breakwater, boathouse lift, or
groin must Ueset bank o minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply tobulkheads ordprapmvetmants) (If you wish howaive the setback, you nwis �sn
the appropriate blank below.)
-- |ODwish tuwaive some/all ofthe 15'oetbank
Signature o/Adjacent R�perienProperty Owner
-OR-
do not wish to waive the 'S'setback requirement (initial the blank)
Signature of Adjacent Riparian Property Own r- 4�
Typed/Printed name of ARPO:
Mailing Address of ARPO* r_�Pll��e
Date: _&LI-0--, waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

N,C, DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTSCATION[WAIVER FORM
.-CERTIF-JED-MAIL - RETURN RECEIPT REQUESTED or -HAND -DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: . . .
Address of Property:
Mailing Address of Owner: A4
Owner's email, 6,M Owner's Phone#:
Agent's Name', Agent Phone', -
Agent's Email: -7,1A J
L
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner
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.
I DO NOT have objections to this proposal. 'I DO have objections to this proposal,
If you have -objeciions to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me
(this does not apply to bulkheads or ripra,p revetments). (if you wish to waive the setback, you must si_q
the appropriate blank below.)
1 DO wish to waive some/all of the 15'setback
-OR- Signature of Adjacent Riparian P�roerty 40wner
I do not wish to waive the 15'setback requirement ,initial the blank)
Signature of Adjacent Riparian Property Own
TypedlPrinted name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
.waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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