Clark, William 88704C

c❑CAMA ❑ DREDGE & FILL N9 88704 A B c D
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 Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone #
Email
Subdivision
City
P
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 rE
Permit Conditions
11 y
(Scale: )
{ U IAK/NAM/NEUSI=/BUFFtK (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 / I
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:
1-1 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

S 1*gjCO W41 ❑CAMA ❑ DREDGE & FILL N0 88704 A B C D
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.deg.nc.Qov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
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 rcyuiicu 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"
Application Fee(s) Check #/Money Order
Signature
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:
1-1 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

'I C3-NT AU"rHORIZATION FOR CAM
Nam of Property Owner ;Requesting, . -nit
N1ailing Address:
Phone Numbel-
[Tall Address: Cl j r�k XAt
I certify that I have aUthorizaci
Agent ' Cori,; scctor
to act on nay behalf, br the. purpose, of appilying for and obtaining all 1A IA permits
necessary fc r thy, follo�,vin Proposed d �3elor)rn nt: t A 1) J,
ty properly ( t;< tc_ � . :: i
,...,,,_."`._._.,, ,-„,
_
., � *.«s�. (. ° , / � ,L ". (p r
jL'i F
1 furth rrrara ce,,tif f that i am authorized to gn,-3int, and do- it) fact grant permission to
Division of Coastal Management ent staff the Local P rg ,art Offficer and their aQents to eater
an the albrementioned i'C,)nds 0 coC"nec"i.on with evaluating information related to this
permit aprilication,
Property Owner Infor aatiow
zV

N.C.DIVISION OFCOASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
(Top portionto be completed by owner or their agent)
Name of Property Owner
Address of Property-,
Owners email:&), Owners Phone#:
Agent's Name-- 0JZ0C?4,,-S Agent Phone#L.-
Agent's Email— �Shlol_e
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
tBottorn portion to be completed by the Adiacent Property Owner)
1 shereby certify that I own property adjacentto the above referenced property. The individual applying fcrthis
permit has described to me, as shown on the attached drawing, the development they are ppnposinO.8
100 NOT have objections to this proposal- _,_|DOhave objections 'to this proposal,
If you �;a­ve_ 6b_ject6_ns i7o what is being proposed, you must notify the N.C. Division of Coastat
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
-understand that any proposed pier, dock moohngpi{ings, boat ramp, breakwater, boathouse, lift, or
gmmmust be set back a minimurn distaice of 15'from my area of riparian access unless waived by me
(this does not apply Uobulkheads ordpropeve4mento) (If you wish towaive the setback, you most sig|
the appropriate blank below.)
-- |ODwish \owaive some/all ofthe 15'oetback
Signature ofAdjacent R�pananProperty Owner
-O,R-
`donot wish tzwaive the '5' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Own C
Typed/Printed name of ARPO: h
Mailing Address of ARPO* /Zaz
Date: waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

N,C.DIVISIQN OFCOASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
(Top portion to be completed by owner or their agent)
Name of Property Owner: Wl"am, L
Address of Property:
Owner's email: ^116/ °
Agent's Name, 45p, I-
AgenCaEmoU:-_
AOJACENTRIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be compketed by the Adjacent Property Owner
1 hereby certify �at I own property adjacent to the above referenced property, T he 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.
{ DO NOT have objections to this proposal. _____ ! D[) have objections to this proposal,
ff you h ve objections to h t is being proposed, you must notify the N.��.- -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, 0CM 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
| understand that any proposed pier, dnck, mooring pi|ings, boat ramp. breakwater, boathouse, |ift, 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 riprap revetments). (if you wish to waive the setback, you must sig
t;eappropriate blank be(owj
~- lDOwish howaive some/all ofthe 15'a
+JRSignature of Adjacent Riparian Pro e�ly- Owner
-
| donot wish toweivethe 16' oatbeukraquinomant(initio| the blank)
Signature ofAdjacent Riparian Property Ownpr
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARpO's erna}k
Date: waiver is valid for up to one year from ARPO's Signature*
Revised July 202Y

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AGENT ALITHORiZATION FOR AMA PERMIT APPLICATION
-nit, USL, U d1A/,
Name of Property Owner Requesting Pert
Mailing Address:
Lh—i
Phone Number: 1c,") - 7 .... . ...... . .....
Email Address: �,A
I certify that I have authon7ed ofA,C7
Agent i C'antractor
to act on my behalf, for the purpose of applying for arid obtaining all CAM A permits
necessary for the f0liovving proposea developrnent: 1--C,-tq, a
V
at my property located at 1-1 rL)k-11 If I Till �e
n
a t an ff)L t I furthermore- cedi�ll � , ,,�m authorized tO grant, and de in, .Fact (7r, it permission to
Division of ("'o-astal Kanagement staff, the 'Local Perrinit Officer and gents to enter
on the U-forementioned lands- in connection with elvaluating ;nformatiort related to this
Permit application -
Property Oearl Information:
"-)r Typrj
Titl
I

N.C.
NDIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
or-R-Y
(Top portion to be completed by owner or their agent)
Name of Property Ownerc.
-
Address of Property:
Arm
---'
Mailing Address of Owner: 30S I 'k0%
Owner's Phone*:
Owner's ernail*,
Agent's Nan,.,e'- Agent Phone4L 2-6
.
Agent's Email _ A—h � volp-t! -PAA 7 CA& --
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
'Bottom 12ortion 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
100 NOT have objections to this proposal. __ 100 have objections to this proposal.
It You have objections to what is being proposed, you must notify the N.C. Division of Coast I aj
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
f 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 riprap revetments). (if you wish to waive the setback, you MpgLsjan
the appropriate blank below.)
I DO wish to waive some/all of the 15'sptbac.k
-OR- Srgnature of Adjacent .Riparian, Property OW1179r
I do not wish to waive the 15'setback requirement (initial the blank)
----45r Signature of Adjacent Riparian Property Own
Typed/Printed name of ARPCI:
Mailing Address of ARPO:
ARPO's email A1,C r_!P
_hy,)C,°tYARPO's Phone#:
Date: 'waiver is valid for up to one year from ARPO's Signature*
Revised 'July 2021

AGENT .,.A Z FOR CAMA PERMIT' ,I `
t 2 f
Name or Prc)perty Owner r;cgLJ StEr-1�� e; r,;z' cam= v� �_ . � L
pp��
f 'q}
Mailing Address,: ddres .
V{" si
1, F..::��_.w.._�.
Phone Number:
EITI�Ii
f
tt Address
I certify that I h ve authorized � ¢
tc act can my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following propose:- developme-int, _) A-ek? C�f
at rny prpr y i€C. �Is
� ' ,�t
ir, SA D ou icy.
/ furthermore GeHIiiy Mat l am a tnhonzed to grant, and do in fact grai ?t L7et`{vision to
Division on Crustal Management emen staff, the i oca/ Permit Officer and tha'1t' agonts to enter
on the aforementioned lands irl connection vlftii elvaluating iribrTri Lion related to this
permit ef)plicatl'on.
Property OwIner Information:
�l
d
Print or Typo N".I ?t�
Tile
irr#., ,?. ...._,..,...,.... ma„F. ,.., -,. .,, ...

A" CH"'OP4 OF COASTAL MANAGEMZNT
AE)JAC;,---Nj-,'- RIPARIAN PRCWERTY WMER, MOTIF CERTIFI[CAT[ C"N't"UVA IVE R F-C)Rj�l
IE----,-� RFTUE
(Top p,—,rit
0'Ainer or
Name P"0i)erty 0�,vnef
Addre,q� j-)f proprty-
Al
gL7
AgsnVs fame,,411;
. . .... . ... .... .... ie
... . . .........
ADJACENT -F,>1PA-Rf/0.jPR0PEr\Ty olAINER'S CERTIFICAT11—IN
I humby caVy vmt I OW, ,y
abov", relgenced propeny 11TIO individuaiapplyjIv
forthis
Permit mas de�'Cj'jjj��Cj to 111P'010IOPI'flietit they ar-Proposing, LN
s—irr�tq-",
=0700 NOT hav€- o4jectioris �c, mm pm,,; 1 DO iS tatfiis oroposaj.
N You have opycdan, t, it `tom 7 b,,_q -
ea. you musi noWy "he Af.c.
jr? 1,�'InWnp 'io rec �ojpt of this
IC 28,�,57. DCj'W rp
MO'l0c'f to '100 C01Mr17Qrc(--, Ave- Ci�jl. il, COUOSPondence should be
_pro�,O�)g.,fjvos car
WOW. Ak) rymD MO is c0n:.in"grod smne as Qchm , 0/50 be contacted
cormod imm fi0f) if I'Vou have beer, notified 4y
I tjnderst.2�1-'d thatany proposen Imeq dc YWAIVEFZ 3q2q(]z-q
OrOif) rtlWit b(9 !�t bmk,�,c.""li bl'r-'W�Ivater� boothou,,ziF,' jift, (g
j)y
(81is G1OeC;)ot'3-pP1k'1 tobugf er rr.(,
'tf MyouWahtowaWhes ihe appropr�,,--jte
1 DO wWh to Wove Same% A 00 >��n V:
-OR. 1-W"."ariao Pi"
now I e
LOS,
COO r,!-,
'M 'iVq A, , ilaii ddi
....... . .. .
Dam, �id A7'r za, 011P yenr fronn "'URPCO's
;,6,1visedJiffy 021

N.C, DIVISION OF —110A$TAill MANAGEMENT
ADJACENT RIPARIAN PROPERTYOWNER TI ICTION1W IVE FORM
E TIFI, D_IMAIL....... Y TURN ECEI REQUESTED or HAND DELIVERY
(i-rp portion to be completed by own r :ar their argent)
Name of Property Ownae
.,. .. ....---�..." .-..
- r � I
Address of rop£r';i i € Ct %
._._ ..._....<__. f......L....._.,..�,...mb
Mailing Address of Oi' neCIL
f
OL'1ner email: EJ,0 f ## i Cu $. w
Ater RIPARIAN ROPERT OWNER'S RTIFi i`ION
(.Bgtt jRgprtrfi3ii U �k! tq! 1<t t i 1 ii f £ i} CC5 3i'! „QYdi1 Pd
I hereby certify that I own proneay r3tsacs<c r° to the above refe encoo property, The rr:.-drvinai applying for this
permit has described 'tC ne, as shown, on the iattacried drawing,the development they are proposing, A
f xt €i£Crr ar Sfrir� iir a. a °.,.It tGit3t iIEIs
i. ?s?al.,.r tj
r g
t N 0 l h 1 v:'o b! a' 3C tl! 7C i t e objections s c
�^..,.,�. �_ � .%sxz.�I. ,-..»-c.....-.-,.-<,.._. � ,._ t`r^,'"3�i-_ f U;�'�-l1f�Y"�" 1� tiltJ �'E','l�i�+1al.
l 1 {go osed, you rr ust notify -the- N.C. Owls -ion- of �oasf,._
Id you �TeiL` �� �cJ�n� to i�fffYe to b€.r{7 �I
Management (Cf ) in writing within 44o days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City. NC 28557. DCM representatives car, also be contacted
at (252) 1 08-2808. PJO response is considered the same as no objection if you have been notified by
Certified Mail.
WAWER SECTION
I €anrtarrrthat any prop:sois pier. _cx,,k, �13ngs, boo ramp. breakwater WaiEuse, Ilffi, or
groin must be :€ a % P irNr4RE y. trirom Inyx , o n0a,0i access t91pss ,-Nail ed btry
1
(this does not,-,Dpiy to bWkheads or ': i; f s€ €f vO' `;Vlsh w;`= Ive the seto ack, you must �I
tt'e, appropriate blank Iae(nnx„
0 Wish to + 3rV<? xom l ail of the 1 ' cr t1ba k " ,i
goatu - -Ii ,u gfiacent Rip<.znan Pfoperly O$f,Jr i�,
1 do not vvish to ,.kaz :1E ','-; 5' setback &"t.itrirZ s".. Tit r ' :-:tfi ? $
r ' I the daralt)
M, < Sion;ahirk of Adjacent Rmarian Properly C� r..
:r
T pecll einted name of ARP :
Mailing Address of ARPO,
: RPO's email:
Sate: _ ..,e�,,,.�'s ewer s valid or rip to one year from AR O's Signature*