87670D-ARLART

Application Fee(s)
Check N/Money,Oriler
.
Iss Date
B
xpiration Date .•,

&❑LAMA ❑ DREDGE & FILL
R,GENERAL PERMIT
W 8700 A B c ..D
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:
I SA 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 # (_) rlr ,L.
Email 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
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s)
a
Floating Platform(s)
A
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 required by:
Permit Conditions
i-
i
(Scale:h71`- )
❑ 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.
f
Agent or Applicant PRINTED Name , / Permit Officer's PRINTED Name
c t � JIMA
Signature **Please read compliance statement on back of permit** Signature
(Please Initial)
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:
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",
N.C.OMSIMOF
AIJACENt
CU.. VUML. MM-I,UfUM 1 MMWUM�?1 MU OFTu4m.0 U
(TqP portion: to, be cornpkW-by owner Or their -agent)
Name:of Property Owner.:
Address of"Propew,
Fo_­
W AICting mdress of -owner. 757 waiting - - � � , � I I ,
Owner's Phone: k.
k 'ho -0 .4' Agents. NaftiBt Agent P ne�- &I
Agefirt BiWe -'�' �_M4
ADJACENTMOAMM PROPIERTYOWNPrO CMRCATION
(B-aftm-portion 't6be-comg1sted hg6eAft Properly Own ed'
the-re-bydefflythAtf-ov--m- properb ab re ,property TheificlividuLA.6p ly­j �Orthfrs yadjacefttidIhe ove -f,-- ced i p
permit has d attached rawingiftclevelop "Pahe ty, ' are, proposlhg -esm mo. -on,". aft
I'DO, NOT. have objections;to this proposal. f b0ave objebdons to thIt prdpokqf.
9 You nova OW00-04s corwbat-'Is be
MimpageMeptifflCM fa writing wMin
md[ed to 127 Cardftaf Dnve W Min
(M), "&M& AtdIIrftPdj"W*_1"d0
CenWecUffsk.
tuydwhilve'
WAVER SECTION
f6ndostand that--,.aq proposed er pier, dWt� . moo n d 9 pilings, boatrampi, Omakmteri bd0ouse, 111%,or groin;
Must -be tat, back -at OnInInwuM ditt6fidd OF-1,61"from my area. of dp6rikh accdss urdew waived by rho (this
dow-not opplyto bWMieads,or,riorap,mvotmen IFyou wish -to Wafve the setback:. you must sign the,
appropriate bli3nk: below.) J
I D4AMS1140, waive soft all ofthe 15-seftck
-OR-
'I clomot.vfth tawaWethd 1-Ssetback.reclutramentQn1lial
Signathre ofAcQjceOktparWa F
Type "rinted namd,bf ARP":
MW[lng,Address:pf ARPO
ARP(ry email;,
10 AA
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3 Our
000; .*waives Is, varid. for up iw.one year from ARPWs Signature*
gelffsed May 202.1,

N.C. DIVISION OF 'COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date -
Mum -
Name Owner ApPlymigfw Permit:
MaiIfug kddress-.
-67/
Icertify that 1, Have authorized (ag
ent) 121 P. to., act on my
behalf,', for the purpose: of applying.for and obtaining all CAMA Permits necessary to
install or construct acavity)
at (my,property located; at)
Thi's certification is valid. tkru. (date)

ENT
,C. SIOR" Tt
kARfAM PROPERTY; -OWNER NOTIRGAT IOMMAWER f, OW
.-bd' ,, � � pefbd b- ' ' i " - - rih- ii 'a g#p t-i td tmm y',awnarror. Ojr, . Re*
;rams ,-df'Prcper*,,CVwnei-
PROPERTY
Agent Yhonem-01m, �1-2-
1,00NOS' hdi!&Obj0006i Ito. hl gtqpop$J,-90. have` ioiijecticttis4&JhWJpt-dp- K
`WAIVER,'SECTION.
moorIng . - i pr oin
must he set [Sack a msn�mum distance of"'i'S` fram rrty area.ofmpacian access _j!�r; 001ti, pill nigs"
unless wa, ,
does not apply to builcheads;cir r prap..revefin6nt§) ttle
you V4 $
p9pr, o ,. py, a bqtKbOow4,
of -the 15` seAbbdk
P-rop'@o Qvrmer
1 do'.nofi wish to waive the: '(5' sett ac{c ,e jrqm tit c, fir too in., a-
Signature.,cif',Aqj,ac6int,:R'O;anan,
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typedlPiffitid M�-OfIA
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*I aRF'p's Signatuer

Date ReceNed
Defe Denoelfed
Check From N,me)
Name olPe—ft Holder
Vendor
Check number
Check
amount
Permk NumbeNComments
Receipt or R.N.&Reallocafed
Columnl
Co1umn2
C fumn3
Column4
Columns
Co1umn9
Co1umn7
Cu1umn8
Column9
8/4/2022
Bud Sniff
Rouleau I 1 of 2)
TD Bank
1001
$ 400.00
GP #87654D
JD rct. 18114
8/4/2022
Burl Sniff
Rouleau (2 of 2)
TD Bank
1005
$ 200.00
GP #87654D
JD rct. 18114
8/4/2022
_
Delta Dock & Boat Lift
Adcock
First Citizens Bank
9374
$ 200.00
GP #87659D
JD rct. 18123
8/4/2022
_
Coastal Dock Builders LLC
Jordan
Bank of America
1033
$ 200.00
GP #87658D
JD rct. 18120
8/4/2022
Pi in Marine Construction LLC
Arlart
Wells Faro
6091
$ 200.00
1 GP #87670D
JD rct. 18124