87779D-UZZELL

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§*�OCAMA`°"`,"El DREDGE & FILL 111-2 ) N9 O% 79 a .8 c
GENERAL PERMIT C ��, Previous permit
J Date previous p rmit issued
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue l
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an L)f (environ/ �I oncern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: .dgq.nc.fov/CAMArules
Applicant Name Authorized Agent
Address — -'' Project Location (County):
City ; State ZIP Street Address/State Road/Lot #(s)
Phone#(—)
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)
Floating Platform(s)
Finger pier(s)
4
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
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit may
Permit Conditions
(Scale:` . Z c> )
❑ 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
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:
F-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

ADJACENT RIPARIAN PROPERTY OWNERS STATEMENT
I hereby certify that I ownri operty adjacent to -' eR _ � . S � 's
(Name of Property Owner)
property located at� qAA ale tfgN_
(Address, Lot, Block, Road, etc.)
on �L s"� -� CXN S —,in Dc.� , N.C.
-� (Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to.this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must file in description below or'attach a site drawing.)
Zx 1� ©de -
I understand that a pier, dock
minimum distance of 15'fron
setback, you must initial the
x
1 do wish tow
Idor
�A,)
WAIVER SECTION
ooring pillings, breakwater, boathouse, lift, or groin must be set back a
iy area of riparian access unless waived by me. (If you wish to waive the
propriate blank below.)
15" setback requirement. ' _---S
the 15'setback requirement.
(Property OwJW&'_Jnformafii6i
�1 7 t }� " � yy1"RS
(Adjacent Property Owner Information)
�,.
iture
�.
d
to
or Type Name
Print or Type Name b -
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„ ? � Y °� ` `q _' .1 IVJa[Iln Andress .` r' , " k M h—` 'mess �_ ..t t. C;� � L .a„ x r r '.`� ..�
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Telephone Number r 3 t `' r� r w yj y' `Y# d' Telephone Number r y
Date

ADJACENT RIPARIAN PROPERTY OWNERS STATEMENT
az
hereby certify that I own property adjacent to J.1i 's
ae of Prope Owner)
property located at 0 y5 � � m� ✓� � e• �� y��
(Address, Lot, Block, Road, etc.)
on YEA 5�cee - ��- S , in 6 ,S710r,J a , N.C.
(Waterbody) ( y)Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
�- have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must filri in description below or affach a site drawing.)
O � r, ¢�
yet
ZILl6��
WAIVER SECTION
I understand that a pier,-dock,�mooring pillings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 1.Vrom1my area of riparian access unless waived by me. (If you wish to waive the
setback, you must initial the appropriate blank below.)
I do wish
I do not
r..
(Property Owner'
Si�gAnt iture
Rim A,y;(
Print or Type Name'
Q k ��`,�
o % 3
Mai ing Address � x
City/State/Zip
a — 9 X1 .nor
Telephone Number f°
tq
Date
e 15'setback requirement.
the 15'setback requirement.
(Adjacent Property Owner Information)
ling.Address' -P TU

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �W � � � � OLJVL
Mailing Address: Oic) qai 'SAT-
Phone Number:
Email Address:, VA ZZ41�Z4?,, /N.4) r r p fV'-'
I certify that I have authorized '_r r Cl,
Agent / Contract r
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development, 2 Y k,b p o c. c �
at my property located at ,
in n n S( o to County.
I 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
Print o`r Type Name T,
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Date_
This certifi

Dafe Received
Date Da Ited
Cheek From Name
Neme o/ Pwmlt Nokler
Vend-.
Check number
Check
amount
PermR Number/Comments
Recel tw Re/und/Reallaoated
Columnl
Column2
Cofumn3
Co1umn4
Ce1umn5
Wells Fargo
Column6
6103 $
Column7
200.00
ColumnB
GP #87612D
Column9
7802
Tmac not. 19349
9/1/2022
Pippin Marine Construction LLC
Perry
UMB Bank, NA
4500 $
200.00
GP #87608D
Tmac rot. 19349
9/1/2022
Craig Miller
same
State Employees CU
4255 $
200.00
GP #87674D
JD rot. 17826
9/1/2022
Toni Hardin
same
Truist
4584 $
200.00
GP #67429D
BB rct. 17938
9/1/2022
____
Johnny Holden Construction, LLC
—..--—___.___,__
same
o_�___
1=.�r.—l-
1002S
4 00.00
GP#87424D
BBrct.17930
§il/20221 Lighthouse Marine Construction Inc Hill ( Coastal Bank and Trust 1 43841 $ 6uu uu = 7r Wlu w�
n f ��aan I