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ICoAS,4,&❑CAMA ❑ DREDGE & FILL N9 87767 A B C D'
GENERAL PERMIT Previous permit
J� Date previous permit issued
[TI 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.Yov/CAMArules
Applicant Name r'I r
Address ` b i ) dltt,Giffi li<
City ` �f t ,F�, State �/i ZIP
Phone #
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot 7v,17
P
Subdivision
City , ZIP
Affected 1-1CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body /� c' G G'f l f (nat/fnan/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity.
(Scale: ,�/� S )
Shoreline Length y ! / �' i
Access Length — — -
j
Pier (dock) length
............ ......._.._... .._. i _.. ..._.. ....._ .._... �...._...... .. 1 _
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 l7
Beach Bulldozing .
Other
SAV observed: yes no - - --
i
Moratorium: n/a yes
Site Photos: yes
.....
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by: ��' r {+�� / t 0�4
Permit Conditions
❑ 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 N Permit Officer's PRINTED Name
Sw a e
Signature **Please read compliance statement on lack 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:
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 Fender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

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I�
� REECEIVED A L 1: 2 2022
DCM WILMINGTON,

u _
Name of Property Owner Requesting Permit:
Mailing Address: lCL
j ° f A- 0
Phone Number:
Address: '
ceaffy #4a'uhave auded �jka
Contractor
to act on my behalfi, fm the pose of applying for and obtaining all CAi11iA►
necessary for thp "owkig proposed development:
Z Lk--� 4+5
at my propelocated at
Rrty
in County.
l furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal ManaWment stag; the Local Permmrif Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
property owner /nation:
qignatury
PhnA. or Type
g�, kv� ✓') ex --
Tithe
At�f;Ejjit-11
JUL 12 ^�
/� RECEIVED
This certification is valid through �1 v ( 1
JUL 12 2022
DCM WILMINGTON, NC

N,C.. DIVISION OF COASTAL MANAGEMENT
�+Ir AOJACDf N'T RIPARIAN MROpEATY OV MER NOTIFICATIOW4NA1VIt* fo + m
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ADJACENT RDPARIAPt PROPERTY OWNER'S CERMICA10"
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asrAisd w rzr Carawnar Dnr� E'xt'. �. NC:ir14i acu P•,prea.r�ir•s un Atso tlra corNActat at
i1 el 7f4 ?2r& No response As ctur ss*rsd Dr►a smmo as no obl"dan of you ha" b*M rOWAed by
GIeDllbd mat
WAIVER SECUM
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"w" be W bpo 0 m wrum eta d 15- rrcrr Pwt at** d! npairun across unless w&VW bV rr* (tPwS
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TypodI Wftd Ramof ARM
aa*ng Address of ARM:��° �. S M A►. n Via. 11 `gin,, ,,.. Nth {
ARPO"s selssN: G A�RRPO's PhOMO: 7� " LQ0i
Dab: 7 z# �' -._ � i�di eip to one y"r from ARPO's Signa m'
Re-vi 8d May 2021
RECEIVED
y - , — JUL 12 2022
DCM WILMINGTON, NC

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL . RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner.
Address of Property:% r ° - - l " • ' _ "%� �__ �.
r
Mailing Address of Owneq�° f "� i j R '' � �L a �►- �s
Owner's email:' )® _ b , _ wner's Phone#:, ' 1� 7-I
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Agents Name: °' U Agent Phone#: Co'7 Z 15_2l
Agents Email: 4-Y tFfOLf J '
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 drawina. 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 objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within.10. days of receipt ofthis notice Correspondence should be
mailed to 127 Cardinal Drive EXT, Wilmington, NC 2W5. DCM representatives can also be contacted at
[phone]. No response is considered the same as no objection if you have -been notified by
Certfied 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 riprap revetments). (If you wish to waive the setback, you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 16 setback lA / /01CiI / /I /1
Signature ofA �a
-OR- ent Riparian Properly Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: M Z�C®
Mailing Address of ARPO:� `Pa'� is ry C,
ARPO's entail: N►'(f. iC.avt�d 9 ARP0's Phone#: 9l .� 7 77 .
Date: G. C ZZ *waiver is valid .for up to one year from ARPO's Signature*
ROWREQE lVH®
JUL 1, 2 2022
DCM WILMINGTON, NC

Date ReceNed
Date DOPOSIted
Cheek From Name
Name ofPermk Holder
Vendor
Cheek numtier
Check
amount
Pmmk Num6erlComments
Recetat a Refund/Reellecated
Celumnl
Column2
Column3
ColumM
Column5
Columns
Column7
ColumnB
0o1umn9
7/18/2022
Raleigh - Wilmin ton InvestorsLLC
same
BBBT
1349
$ 200.00
GP #87752D
BH not. 18068
7/1812022
Allied Marine ContractorsLLC
John
First Citizens
11273
200.00
GP #87767D
JD not. 18105