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,I, ' FLAMA ❑ DREDGE & FILL N9 85809 A B C D
Previous ermit
GENERAL PERMIT /
P
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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
Affected ❑ CW
AEC(s): ❑ OEA
nRw•' o /.
(e, f
-` States `' ZIP
❑EW ❑PTA
❑ IHA ❑ UW
Diue • ..o� /...
Type of Project/ Activity
anoreune LengEn,
Access Length _
Pier (dock) length
Fixed Platform(s)
nvaung nauv� nqo�
n %g Pn JhJ
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/Boatlift�p `% 1
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zonin ermit ma be re uired b
Permit Conditions
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s) _
Subdivision
City ZIP
Adj. Wtr. Body (natJman/unk)
Closest Maj. Wtr. Body
iacaie:/w,"; I
B p Y 4 Y•
❑ 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 pnt PRIN D Nam Permit Officer's PRINTED Name
Signat re "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:
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

AGENT'AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Vill sxgo�
lz�!V
Mailing Address: ex(%,
Phone Number:
Email Address:
I certify that I have authorized Nicholas Caftan of N.C. Marine Construction
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA//permits
necessary for the following proposed development: 9 44 r'irY r .
at my property located at 2L .50)
in Pewl)w County.
I furthermore certify that / 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 or Type Name
(-) &t�e/
Title
Date
RECEIVr=D
This certification is valid through / ! D3 DEC 0 Ian
DCM WILMINGTON, NC

Sx I crtic. Cr r4rR--
ANA tO 4 Z+ I —00—T I 14
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SAIIST44S
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RECEIVED 6 v 1
m 60.
DEC 0 1- Z022
�J4� �a vat �� �
ACM WILMINGTON, NC

I hereby certify that I own property adjacent to C � `�-�� ��� ,)' Wald s
prc
on
jvuy1 i Uwe dFlutur ir®Ufliy)
The applicant has described to me, as shown below, the development proposed at the above location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the setback, yot; muss initt the appFopriate blank below.)
I do wish to waive the 15' setback requirement.
not wish to waive the 15' setback requirement.
(Pro wn Information)
(Adjacent Property Owner Information)
�-
(L
t atzwe
Signalttr
P Typ Nam
�C
�• ��-eu�w.�
Print or Type Name
I4A,9
can
F
z
Mailing Addrp s J f
?
Mailing Address
w
r
City State2ip
s
City/State2ip
@S
C3
M
Tele hon Number
p
7o -
9-/o — y7Z' - 0 3
Telephone Number
,��-
'// K
Date
Date
(Revised 611812012)

I hereby certify that I own property adjacent to Pi`(Na�r` �yr /rty
property located at
cl �:e/�fV e P i°_ . Owner) ��ot
on _ d n (Address, Lo BlockLRA� ptc.) A�el'
. in ' In , N:C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
•S ' I have no objection to this proposal.
I have objections to this proposal.
uts%;KIP I ION AND/OR DRAWING OF PROPOSED, DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area�of fnanan, apcessunless waived by me. (If you wish to waive
,,�
the setback, you dose i�he appropriate blank below.),;
I do wish to waive the I& setback requirement.
not wish to waive the I & setback
(Pro rt wn !n#ormation)
�nn r
ig191 4e l �1 115/f'/� 1,27%'�P
Pr Type Name`/�
Mailing Addrp
City tateop
Telephon Number
//-/s-C�
Date
Property Owner Information)
Signature
Print or Type Alame
826 Is A1E J d.
Mailing Ad ress
o S4; I 3.0
City tateMo
`1ft ^ 3a8 --
Telephongg Numb r
I f / X3 7.4 a �?-
Date
(Revised 611812012)

Dote ReceNed
Date De Ited
Check From(Name)
Name of Permit Holder
Vendor
Checknumber
Check
amount
Permtt NumbedComments
Recel t or Relund/Reallocoted
Column!
Culamnl
Cdumn3
Column4
Column5
Columns
Column?
Co/umn9
Column9
12/13/2022
James Helmick
same
Wells Fargo
6897
$ 600.00
GP #85960D
PA rct. 18633
12/13/2022
Donald Reames
same
Bank of America
131
$ 600.00
GP #87644D
BH rct. 19892
12/13/2022
North End Builders NC LLC
Newpol
Truist
1189
$ 200.00
GP #86060D
BH rct. 19894
12/13/2022
Coastline Therapy Group, LLC
Ba eant
Wells Faro
27454060
$ 400.00
GP #87539D
BH rct. 198B2
12/13/2022
McPherson Marine Services, LLC
JMSM Holdings, LLC
First Citizens Bank
5702
$ 200.00
GP #87680D
Tmac rct. 17809
12/13/2022
Charles Fox Homes, LTD
Gosnell
Branch Banking and Trust
30256
$ 200.00
GP #85846D
BB rct. 18699
12/13/2022
Devane Family LLC
same
First Bank
1531
$ 200.00
GP #85843D
BB rct. 18696
12/13/2022
Harbor Marine Construction, Inc.
Sarbone
Bank of America
1399
$ 200.00
GP #85809D
JD rct. 17872
12/13/2022
Womack Electrical Contractor LLC
same
South State Bank
1493
$ 200.00
GP #87582D
TP for BH rct. 17829
12/13/2022
Willard Family Farm LLC
same
South State Bank
1843
$ 200.00
GP #85853D
BH rct. 19895