Henry Moore - 90092C

"VOW,, lCAMA N90092
B(C? D
GENERAL PERMIT Previous permit
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 deo nc gov/�CAMAniI s
Applicant Name
Address �1-
City State _ ZIP
Phone#(') t. rtl
Email
Authorized Agent i
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑'PTA ❑ ES ❑ pT5 Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/(' -
Type of Project/ Activity
Shoreline Length I
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
Boat ramp_
Boathouse/
Beach Build
Other
SAV observed: yes no +�-
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: 'yes no
A building permit/zoning permit may be required by:
Permit Conditions
(Scale:i - )
❑TAR/PAM/NEUSE/BUFFER(circle one)
.zl ❑ 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.
.
Agent or Applicant PRINTED Name 0'.I
Permit Officer's PRINTED Name
Signature **Please **Please read compliance statement on back of permit**
Application Feels) Check #/Money order
Signature
Issuing Uate
(Please Initial) 1-,
,l.
Expiration Date

QCAMA ❑;DREDGE & FILL N9 90092 A B C, D
3 GENERAL PERMIT Previous permit
.-�
❑ New []Modification ❑ Complete Reissue []Partial Reissue Date previous permit issued
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: wwwdeq nc gov/CAMArules
Applicant Name
Address
City `' I.
Phone fl
Email
Authorized Agent:
Project Location (County):
State ! I ZIP "fit (' � Street Address/State Road)
Affected ❑CW f❑-EW 'PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length d
Access Length
Pier (dock) length
Fixed Platform(s)
rloating Platform(s)
ringer pierls)
Total Platform area
Groin length/# i
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill _
Max distance/ length T
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
yes
no\
Moratorium: n/a
yes
no
Site Photos:
yes
no
1 _---
Riparian Waiver Attached:
;ye?
no
I-..
A building permit/zoning permit may be required by:
Permit Conditions
❑ ES ❑ PTS
❑SPIMA ❑PWS
Subdivision
City
Adj. Wtr. Body
Closest Mal. Wtr. Body
r.
t.
ZIP I
(nat/man/unk;
(Scale: I - ',o)
e
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
ElSee 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) l'
Agent or Applicant PRINTED Name
f
Signature **Please read compliance statement on back of permit"
r
Application Feels) Check#/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: I.-tVV & L, m oor-c
Mailing Address: P��� M Z
I 1 hL r N . ef- , Z�32C4
Phone Number: G p 'Z 1 2 22
Email Address:
certify that 1 have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: r eA �) k:l-� U ��
at my property located at S 2-2-)
in - A 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 Information:
'n�U 1ti�n'
Title
Z
Date
This certification is valid through
"RPCEIVED
APR Z 1 2V7
DCM••MHf) CITY

1S
I hereby certify that I own property adjacent to _
property located at (Addr+esa,
on ��9 f y in.
(Waterbody)
The applicant has described to me, as shown
location.
' < I have no objection to this propo
DESCRIPTION AND/OR DRAWING
(Individual proposing development must fill in
Property
N.C.
the development proposed at the above
F PROPOSED DEVELOPMt:N r
tescription below or attach a site drawing)
TJ fE D51S
U 1") aer
F-1eVi40>L
L.', fE i
AItt�K 5 c. I "J -
I understand that a pier, dock, mooring pilings, b akwater, boathouse, lift or groin must be set
back a minimum distance of 15' from my area o riparian access unless waived by me. (if you
wish to waive the setback, you must initial the a propriate blank belgw.)
—_— I do wish to waive the 1 S setback uirement.
1 do not wish to waive the 13 setba requirement.
VICyy--t
Telephone Number
Date
(Adjacent Property Owner Information)
Z
'�FCFIVED
APR 21 M3
(ReWsed M "eR-MHD CITY

I hereby certify that i own property adjacent to
property located at "" S—
l!gddross,
on �� t"�� in,
-aterbody)
The applicant has described to me, as shown
location
}( I have no objection to this propo
DESCRIPTION AND/OR DRAWING
(Individual proposing development must fill it
�,�/
(Name
I
N.C.
, the development proposed at the above
iF PROPOSED DEVELOPMENT
fescriptton below or attach a site drawing)
CiS
\ T)ri~o5'
E�Vb>L
w
I understand that a pier, dock, mooring pilings, bil akwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area o riparian access unless waived by me. (If you
wish to
waive the setback, you must initial the a propriate blank below.)
�\ 1 do wish to waive the 15' setback re uirement.
1 do not wish to waive the IS setba� requirement.
(Property Owner Information)
M fling Address
( -3ALl
City/Ste
ilr� _21y-2�2�
Teleph a Number
Dare
Owner Information)
04
.........
- ti Z"]— �// O q RPVF:tvF:o
Telephone Number
�- 1 -2oz�
Dare APR
(Revised C/461704kif) ClTy