92534C - Jones, Russell

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,��F`° 4'4, ❑CAMA DREDGE & FILL No 92 534 ABCD
y�0
a : GENERAL PERMIT Previous permit
Date previous permit issued
❑New ❑Modification 1 I 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:
I 5A NCAC �`-1 ❑Rules attached. ❑ General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent ?IA IL kfr)
Address Project Location(County): f ) /i 1,) -
i
City I` ' / State ZIP Street Address/State Road/Lot#(s) 14
Phone#( % ) ` Pam ( `)C
Email Subdivision 1 i, k .
_._._
City ZIP 49 �
Affected ❑CW I I EW 11 PTA ❑ES I I PTS Adj.Wtr.Body ' .1 V_ (_. f (nat/man/unk)
AEC s: ❑OEA �IHA ❑UW ❑SPIMA 1 PWSClosest Maj.Wtr.Body i /( •( li 47� ,U,6
ORW:yes/no PNA:yes/no —_.
Type of Project/Activity !2\(it 1 �I Xr-iLl � 1 41 ' U"
(Scaler ))
Shoreline Length
Access Length ---"' , , - .�_ ,,;``1, — -i i 4
.�.JW /! I-A •,/. / 1
Pier(dock)length _ ' 1
Fixed Platform(s) � . 4141V1. .. I v ��,�a -
i
111111MPW:61151511A111111MW
IA IFloating Platforms)
aim am
Finger pier(s) al �•w �l-a..'�
IMMEIIIMIr
Groin length/ff 'Total Platform area �u��-�• � �lrt l
oililin ,1
e
Bulkhead/Riprap length �� - --f- / ��" .--
Avg distance offshore +_._.. ;_.. _ .._�__—_ __ __
1
Breakwater/Sill IIIIIIIII.MIIIIIIIIIIIIIIIIIIIIIIIIIIII ILIM" I
Max distance/length — -=IMIIIIIIIIIIIIIIIIIIMIIIIII 1�171 `
Basin,channel t •►�• .Il,�-
Cubic
yards - 1. -.._...... _. ...._. f ..._.... ,....... _.. •
_.Boat rampr_._._ .. _. ____ __ i - -----
Cubic e/Boatlift • L�a�•- a �� _
Beach Bulldozing I"r'lig.s 1
Other417) f___..._ -..___..._ _._.._.._... ...._..._._.._...._..
SAV observed: yes no mmiminum 11111111111111111111111111111111111111
Moratorium: n/a yes ' no N1�'��� ma'■m' .
Site Photos: yes no �_..Y�._� 1r ti MIIIIIIIIMIIIIIINIIIIIIIIIIIIIIIIIIIIIIIvfnow _mitiliw••
Riparian Waiver Attached: yes no =OM Mr l aimainfinmwokroII!alMinlinliMINI11111111111111111111111
A building permit/zoning permit may be required by: 1�
Permit Conditions I - ❑TAR/PAM/NEUSE/BUFFER(circle one)
' y f L ❑ 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 fPlease Initial)
l,N Hili ,c,,,,,'
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name/ r
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:
Tar - Pamlico River Basin Buffer Rules 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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St.Ste. 300 127 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

o1,0"Mr41NriCAMA DREDGE & FILL No 92534 ABCD
1'
71 u.
GENERAL PERMIT Previous permit
Date previous permit issued
['New n Modification ( I Complete Reissue n 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:
I 5A NCAC n Rules attached. n General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address ,d ' ait
Project Location(County):
City_ I l ) State // / ZIP Street Address/State Road/Lot#(s)
Phone#(_) e/ f.i
Email Subdivision
City ZIP
Affected n CW IT EW PTA n ES n PM Adj.Wtr.Body (nat/man/unk)
AEC(s): ❑OEA fIHA I I UW n SPIMA n PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scalel 1 0 f)
Shoreline Length I
Access Length —_ _ -j -_ . _ I ,_._,.......� ._
Pier(dock)length
1 - .4 i
(� f
Fixed Platform(s) fly j , l 1 )A ,t `-
Floating Platform(s) a^J
I' 4"111rili4 'Finger piers) „ '�i
! ._�. .
Total Platform area ..., __ ..,... _ lop I _ - RE.
Groin length/# i
Bulkhead/Riprap length i f
1 _ f ,1 ill
Avg distance offshore i.
t
Breakwater/Sill _ 1 1 � 1. i 1
Max distance/length I i ; i 4 . 1 , '1 ( , , i 3
i
�� F i j
Basin,channel _ , i 5_ {:
Cubic yards �_ i
--
Boat camp I
1
_.
�
Boathouse/Boatlift , "' -( .
Beach Bulldozing 6 I Ij
Other
i I 'I,
SAV observed: yes no
It
Moratorium: n/a yes no 4.11 I r ' I
Site Photos: yes no - --- - I
Riparian Waiver Attached: yes no . a I i - ,�..,L.
A building permit/zoning permit may be required by:
TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
nSee 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:
Tar- Pamlico River Basin Buffer Rules 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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax:[phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste.300 127 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPQCATION
Name of Property avrer Requesting Permit i?.2;•4 St.nfn. _ _—
. . Maimg Address ?at3vr 73 t —
12.c�.t.,..ky rk( a!Sri —.
Phone Number: ?lo SIN-`ito/
Email AOdreSS: � f tones bu,irtrrs H 1"4
I certify that I have authorized _ I
— Ctk2-i(k_ i Die.,
Agent r Contractor
to act on my behalf.for the purpose of applying for and obtaining all CAMA permits
necessary for the Fal'omuig proposed deve:opment:
1:3 X n' p 1
at my property located at 123 I Ar/f i ds i'j ICI I4oi1I! Ni r1Qt
in eilS)r-i. County f l
t furthermore certify that t am authorized to grant and do in fact grant permission to
Division of Coastal Management staff, the 1°cal Permit Officer and their agents to enter r•
on the aforementioned lands in connection with evaluating information related to this
permit application.
OAI Property Owner In'ormat on:
Srgnalunz
i uyS<i' Jdnec
Annt or Type Name
d . 7ittA
A.
.Q...IJn i -3
Date
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This certification is valid through /2-- t, 3/ f i023
i
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N.C. DIVISION OF COASTAL.MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIE ED MAt R-t !'N R CFIPT EQ t S t�qt AM)DELIVERY
(Top portion to he completed by owrtot or their agent)
harm*re Property O*ter A s 1 ioi
Add-ass a+ProPefTY 113
Tnr 1wl t ` ] b '1ndge. N.0 .
rk,,„Ng Address at Owner. PD. LS238
2s7g1
Owners a r ixt Owner's Phones: Q IC',SKq ,'YtdO1
Agents Name 1?i i k ntl)IIA%.if i Vim Phones: tD-3 Er5JiD
Agenrs Emit p.d_C _sinkiiclk a114inail ,rcm
ADJACNIT RIPARIAN PROPERTY OWNER'S CERTIFICATION
rierMeeiISIMMI b l>•Shcmotetad htit .AddlacentProt.itit_9Jetll4Ll
I hereby certify that I owi property adjacent to the above referenced property.The indrvidual epP+yirul for
tr.s perrlvt has descnbed to me as shown on the attached drow:ris the development they are prc-pos.no
or drairtPs2-with dimensions_InUlt(7i..PtPUlSLYtlth
., I DO NOT have cbechors to tW propose! _ I DO h:lae ohjeC'wns cc a prcPcsal
if you have objections to wrier is being proposed,you must notify the MC, Division of Coastut
Management(DCM)in writing wifhfr+ 10 days of receipt of tills notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 2BK57. 0CM representatives can also be
contacted at(252)6164400. No response is considered the same es no objection if you have been
notified by Certified Main,
WAIVER SECTION
understand that any proposed pier dock mooring wings boat ramp.breakwater,boathouse,I R,Or
a a n must be set back a r n mt m d.sbnce of 15'from my area of rpanan access un'ess waived by me
ttirs does rot apply to bulkheads or riprap revetments) (if you wish to waive lho r eltlaCK you aniatlign
the appropriate blank below
100 wish to waive some/al some/20 of the 15'setback
(' ) c
Signtrura ofAdloctrrtr w an ropur1y Oiwler
-OR-
I do not wish to waive the 15'setback requitement(initiaall the blank)
Signature ofArtacer.t Riparian Pro outm perty er� � 4267
'Piped/Printed name of ARPO: (�nt-''(fL9 �'Y4 r 1 ] 1
Mailing Address of ARPO: I t(Jt-1 ) J ct l f .,t 4�Iz�il1[� �1� 1 V
ARPO's email: ARPO's Phos*X:"I+U -3 1 Q t
Data: Li` �L 'waiver t s valid for up to one year from ARPOb Signature'
TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION&WAIVER FORMS
Revised May 2021
�vGtlJlL'Q and Revised

rv.V_ IJIVlSlun UI- t:tJAblAt.MANAtitMlNI
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED M AIL RET URN R CEIPT REQUESTED or tiAND DEL1/ERY
(Top portion to by completed by ownor or their agent)
'Marne of Proae-ty Owner ILSS�' I I
Address of Property 7 Z.3
�� Lktm j ry`C Eli. ( j
Waling Adorers of Owner. Fill y RAj IY .l / I P0, i}r-)C] R RalaNdi Nc. 28571
Owner's email 7 Owners Pto : 11D 389-Y601
Agent s Name. 'rick flatiori Agent Phone.' cp-330--5a ),i't
Agent N'`s!;mail: ) CL, CD r,) rrnr (Om-Marl JOIYl
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
` gDjg ktgornofet.d I!y tI AdlaCent Proglftty Qwn4G
Iu.reby cert'y that I own property adacent to the above referenced property, The ind'viduat applying for
this puma h:r(.deserted to me, as shown on the attached drawing,the development they are proposu'A
i4 ,g notian Dr ttr�iri�rS.5rn ULr!sCf im stbe rovI bJcttcr
('"( ', l DO Nol have objections to this proposal I DO have objections to this proposal.
if you have objections to what is being proposed, you must notify the NZ, Division of Coastal
Management(ACM) in writing within tO days or receipt of this notice. Correspondence should be
mailed to 400 Cam/nerve Ave„ Morehead City, NC 28567. DCM representatives can also be
contacted al(252) 615.5400.No response Is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed per,dock moocng pilings,boat ramp,breakwater,boathouse,',in.or
groin must be set back a minimum distance of 15'from toy area of riparian access unless waxed by me
Iths does not apply to bulkheads or r.prap revetments).IIf you wish to waive the setback,you fin
the appropriate blank oelow.)
I DO wish to waive sorneta:l of the 15'setbackor ,r
Sr rlolute.�o1f�Ad cant Rip run Propett r Owner
I do not wish to waive the 15'SetbaCh requirement(initial the blank)
Signature of Adjacent Rpanan Property Owner. , ,
TvpedlPrinte Dam d e of ARPO:_�.ln7rtt' ICtU
Malting Address ofARPO: i1180 5• Rif key U , 1-611$ Ri� 1.
ARP a's Steal!: ARM*Phoned: 9iv- 3� -O112.
Oat*: 6t',?� — 01.I 'wahter is valid for up to one year from ARPQ's Signature'
TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION&WAIVER FORKS
Revised May 2021
(Obi(M CA,' €21 k

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