87549D-KENNEDY

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❑CAMA ❑ DREDGE & FILWkC
NO 87549 A 8 C . b
3
GENERAL PERM Q ITS Previous permit
J Date VevioLt permit issued
-M New []Modification ❑ Complete Reissue [:]Partial Reissue 1 jr/ J ,(
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commissio in an1he
a of environmental concern/ rsu t to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at following link: www.deq.nc.gov/CAMArules
Applicant Name I' Authorized Agent X
Address t, 1 f Project Location (County):
City ' State ZIP Street Address/State Road/Lot #(s)
Phone # (_ )
Email
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS
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
Subdivision
City 7i' . 7j ZIP rl t. f (f
Adj. Wtr. Body ll"f , ' i (nat/man/unk)
Closest Maj. Wtr. Body
SAV observed: yes no;/
Moratorium: n/a yes f
Site Photos: yes 4i0
Riparian Waiver Attached: yes no [
A building permit/zoning permit may be required by: I
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 oAApplicant PRI D Na
144 �.
Signature "Please read compliance statement on back of permit"
Permit Officer's PRINTED Name
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:
1-1 Tar - Pamlico River Basin Buffer Rules F-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

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4075 4th Street
Surf City NC of YWCd
Legend
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4075 4th St
' Existing Deck 180 sq/ft
Feature 3
Property of
0 Proposed Extension 215 sq/ft
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to Property Line z
to Property Line jD 0
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: �� ! ' ©x __2_,3O 3
Phone Number: 3 9 5
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: xj ilk
at my property located at �b 757
in ��s l'o w County.
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
i ure
Print or Type Name
Our e_r
Title
lv I 4 1 LD 2.2--
Date
This certification is valid through
RECEIVED
OCT 2 4 2022
OCM WILMINGTON, NC

N.C. DIVISION OF COASTAL MANAGEMENT �4�vl
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to
be completedbyowner or their agent)
Name of Property Owner: Ae--,,ta
Address of Property:
Mailing Address of Owner: /� 6 (3ox 2,363 5 K,/), RV c 2gy y7
Owner's email: 'D wner's Phone#: F/,o - d-P 3 Sp
Agent's Name:
Agent's Email: _
Agent Phone#:
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 drawinq, with dimensions, must be provided with this letter.
__X 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 of this notice. Correspondence should be
mailed to 127 Cardinal Drive EXT.. Wilmington, NC 28405. 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 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 15' setback
-OR- Signature of Adjacent Riparian Property Owner (ARPO)
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: V W ciL4 l GA2G�r�r�a
Mailing Address of ARPO: qo � W H S I . Sykr- on, I , &)c Z la yyj
ARPO's email: VIN (. UAF-i j` a- COM ARPO's Phone#: M. r6 r �M
Date: *waiver is valid for up to one year from ARPO's Sig
&- IN/ FV
Revised May 2021
OCT 2 4 Z"
DCM WILMINGT-

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 anent)
Name of Property Owner:
Address of Property:
Mailing Address of Ownei
Owner's email: .r atVo4c&q Owner's Phone#: 1,9 jkV -z;,s 'T
r
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPAR!A"1 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,
It 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 of this notice. Correspondence should be
mai.'ed to 127 Cardinal Drive EXT, Wilmington, NC 28405. 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 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 15' set`""'
-OR-
Signature of Adjacent Ripari roperty Owner (ARPO)
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: tj
Mailing Address of ARPO: Yg Q/?
r '
ARPO's email: 7� —eZ5 #I i'a ARPO's Phone#: '�'L� � � �4�
11.s`
73
Date: '� b-;7 *waiver is valid for up to one year from ARPO's Signature*
RECEIVED
Revised May 2021
OCT 2 4 2022
DCM WILMINGTON, NC

Date ReceNed
Data Deooalted
Check From Nana
Name of Permh Holler
Vendor
Check number
Check
ounf
Permit NumberlC=mema
Recelet or Refuhd/R.11—fed
Column
10/28/2022
Co1uma2
Column3
RG Marine Contracting LLC
Column4
Eubank
0o1umn5
Bank of America
C.1u nS
1114
Co1umn7
$ 200.00
Columne
GP #87454D
- Co/umn9
KB rct. 17877
10/28/2022
Island Contracting, Inc.
Carter
Truist Financial
39363
$ 200.00
GP #87513D
Tmac rct. 17806
10/28/2022
Coastal Marine Construction
Scott
Wells Fargo
24624
$ 200.00
GP #87648D
BH rct. 19880
10/28/2022
Coastal Dock Builders LLC
Martin
Bank of America
1040
$ 200.00
GP #87799D
JD rct. 18729
10/28/2022
Allied Marine Contractors, LLC
Near
First Citizens Bank
11566
$ 200.00
GP #87677D
JD rct. 17773
10/28/2022
Southern NC Marine LLC
Garner
First Bank
1560
$ 200.00
GP #87548D
JD rct. 18728
10/28/2022
_
Logan Marine, LLC (1 of 2)
Roof
Truist
8173
$ 400.00
GP #87460D
KB rct. 17879
10/28/2022
Logan Marine, LLC 2 of 2
Roof
Truist
8172
$ 200.00
GP #87460D
KB Rtc. 17879
10/28/2022
_
Agriment Services Inc.
KennedySouthern
Bank
8958
$ 200.00
GP #87549D
JD rct. 18730
10/28/2022
_
Brandi Aschbrenner
same
I Bank of America
447
$ 200.00
GP #87678D
IJD rct. 17855