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❑CA%1/IA ❑ DREDGE & FILL Ca 1C).
-3G ENERAL PERMIT �ffQ�Previous permit
C w7� �) Date previous permit issue
New ❑ Modification ❑ Complete Reissue ElPartia Re' sue �C I-Ik-
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of envfr I concern pursuant to:
I SA NCAC 4 ' ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address L L iY Project Location (County):
City State VlL_= ZIP Street Address/State Road/Lot #(s)
Phone#(—) ' €y1
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(
Finger pier(s) _
Total Platform are;
Groin length/# _
Bulkhead/ Riprap
Avg distance offsh
Breakwater/Sill _
Max distance/ lent
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatli
Beach Bulldozing _
Other
SAV observed:
Moratorium: n/
Site Photos:
Riparian Waiver Al
A building permit/zoning permit may be required by:
Permit Conditions
Subdivision
City
P
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
(Scale:t, •,, )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
ElSee 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
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
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

t
Name of Property Owrar Requeeft Fowmit
Mailing Address:
Phone Number
i 1""
t
cerW that t have authorlaed /l l�v� ' kllfrCcd.•f11f �'i
AQwdICWbVCIOf
to act on my behalf, for the purpoas of appift for and obtaining all CAMAS
necessary for the follomfi tg propowl devetopm nt
at my property located at 304 a ` -y�� e: C- ;�Lg I �
In v� �� - t`�s�``�J ..."--County.
I furthermore certfftr that ! am euthnrrzed to grant, and do in fact grant permission to
flivlsron of Coastal Management start the Loral Pemtft QWwr and their agents to enter
on the aforementioned lends in connection wig evetuakhg informatlatt rolated to this
porn* application.
Property owwr trO matlon:
9�2
Pldnt or Type Name
k valid through _ l�..._._.�.i'�.____..�-.

Date Received
Data Deooslted
Check Fran Name
Hamed'Pe—ft Holder
Vendor
Check —her
check
.mount
Permit Num6edCemmenh
Recdet a Re/undlRealleceted
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8/4/2022
Bud Sniff
Rouleau (1 1 of 2)
TD Bank
1001
$ 400.00
GP #87654D
JD rct. 18114
8/4/2022
_
_
Bud 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 Amedca
1033
$ 200.00
GP #87658D
JD rct. 18124
8/4/2022
Pippin Marine Construction LLC
Adart
Wells Faro
6091
$ 200.00
GP #87670D
JD rct. 18124
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