87597D-ROACH

LAMA ❑ DREDG4 & FILL N° 87597 A B C
GENERAL PERMIT �� Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissuegf l a
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area env onmental concern p sua to:
15A NCAC 0 t Jy1 w ❑ Rules attached. [�J General Permit Rules available at the following link: www.deq.nc.Yov/CAMArules
Applicant Name
Address 7 l 11 G,d
City v4tkkk
State N C. ZIP 2y�c
Phone # ( ) 1 o ( ((-
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Affected ❑ CW 0 EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body. .�L U 1 �� C (�n� an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no: PNA: ye Ft
Type of Project/ Activity N
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) X ,
Finger pier(s)
Total Platform area 1? U f'
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
—4—
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes o
Site Photos: yes
Riparian Waiver Attached: es , no
t
A building permit/zoning permit ay be required by:
Permit Conditions
11 F a4,-1':
(Scaler -VJ 1
❑ 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 Name Permit OWkVY sFRTNT D,Name
-o.
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check #/Money Order Issuing Date Expiratin 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 6dminarl 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 F1 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

1
I hereby certify that i own properly adjacent to
- s
property located at S' l p� :y� -�- , A oaf Property owner)
on P ��iN ,AYYx�=!!�;Caltyf
@t )
( aterbody)N.C.
n andlor County)
The appliq t has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal._
I have objections to this proposal.
DESCRIPTION ANDIOR DRAVYING OF PROPOSED DEVELOPMENT
(lndfvidual praposfng development must #II in description below -or attach a site drawing)
De FlDe_A�ikvls
WAIVER -SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a:_
minimum distance of 16 from my area of riparian access unless 'Waived by me, (if you wish to waive --
the setback, you must -initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement. -
do not wish to waive the 15' setback require
eTiIYIVPDNAIaM
..,,vrUlal �) ( jacent Pro e
P rty Owner Infonnatic
111�!Pnfint
e
0 or Type
Lve
crtyistbter�
Tele hone Number
Date
C 2.9577
(Revised 6118,2012)
3
,

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: YO CL
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
0
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: o-
at my property located at
in rU 5 0ounty.
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.
Print or / ype Name
Dc J&
Title
Date
This certification is valid through ) � l I '-� _l13
r

3 7 / �j S die%� �� iZ � ,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
t hereby certify that 1 own property adjacent to
-
property located at �� me of Property Owner) 's
on (Address, Lot, 8 c[c on 'et )
in
aterbody) ' N.G.
CityPfown and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
� n.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTIONAND/OR DRAWING Op PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing
)
!�)o&--" V\ 4, .e
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, you must-inifial the appropriate blank below.)
I do wish to waive the 15' setback'requirement -

Date R—Ived
Date DePosited
Cheek Fran Neme
Name&P—It Holder
Vendor
Cheeknumber
Check
amount
Pertnit NumheNCorn—t
Recelot or RelundlReelleeeted
Cdumal
Column2
C.1-3
Coumn<
Columns
Column9
Column?
0o1umn9
Co1umn9
11/21/2022
11/22/2022
Gregory Holden
Roach
United Bank
5592
$ 200.00
GP #87597D
BB rct. 17915
11/21/2022
11/22/2022
B and B Marine Construction
Fleming 8 House, LLC
Wells Faro
2008
$ 400.00
GP #85802D
JD rct. 17861
11/21/2022
11/22/2022
CD Jewell
same
USAA Federal Savings Bank
1290
$ 200.00
GP #85384D
JD ret. 18737
11/21/2022
11/22/2022
Li hthouse Marine Construction Inc
Hilker
Coastal Bank and Trust
4474
$ 600.00
GP #87602D
JD rct. 18736
11/21/2022
11/22/2022
1 AMW Docks and ME
ITruist
8011
$ 200.00
GP #87500D
BB rct. 18691
11/21/2022
11/22/2022
e2ory Holden
Allred
I United Bank
1 5690
$ 400.00
1 GP #85813D
I PA rct. 17749