91244C - White

co"S'a,, 9CAMA El DREDGE & FILL :� ' - � � A B © D
° �� Previous permit '"—
GENERAL P E MIT
Date previous permit issued v
,cry New Modification om lete Reissue Partial Reissue
__. ❑ P ❑
As authorized by the State of North C a,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC '114 Rules attached. :� General Permit Rules available at the following link:www.dN.nc.Qov/CAMArules
Applicant Name KiENULA W 1A ITE Authorized Agent FNNEr r FARINA CONSTt "A-11ON
Address .113 LAG uvA LANE Project Location(County): ON-5Lb1f',,)
City JAt}CSotmt-"c State N c. zip c2s,51D Street Address/State Road/Lot#(s) �213 I.ACltaNA Lwr
Phone#(_)
Email Ar.r•J ;4f,iZ01312 ot-Npok cam Subdivision LA61.NA '9AT
City. JAc e5pov►t.LF zip ;�8510
Affected 9 CW ZEW X PTA ®ES ❑PTS Adj.Wtr.Body 14E W J?lyF-t na an/unk)
AEC(s): ❑OEA ❑IHA UW ❑SPIMA ❑PWS Closest Mal.Wtr.Body__.N e.w Q►VER
ORW:yes no PNA: ey yno
Type of Project/Activity KEP Ass 4 A.
5r WE ExrSTIN6 SLK► EAp CDN5T&LtLT N6w IS bocKINCA FAcsa TJ 1N1Tk1
FINGER (119M AN b 1 0 K JaaATLJFr1 ,ANb 5 K Zr) tT l_If'T (Scale: 1,20 )
Shoreline Length 45'
Access Length 1 I
rr o
Pier(dook)length 9 t X`iS
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) 3 xZS t �• x t3 jc
Total Platform area 119
\ , O
Groin length/p ✓
Ikhead Rlprap length
`�4�-
istance offshore.�'7
Breakwater/Sill
Max distance/length
Basin,channel
Ql A6 S
Cubic yards Off,
Boat ramp
Boathouse Boatll I3 if 13 J 10'14 1 @ a"VDY,
Beach Build/p�zing
�O her ,"1�K Q a,
Y►vta�:�c.d SI�oS s 6
SAV observed: yes i �F
Moratorium: n/a
Site Photos:
Riparian Waiver Attached: no 1
A building permit/zoning permit may be required by: N G�01'"V t t/1, ❑TAR/PAMINFUSE/BUFFER(circle one)
Permit Conditions(D�V 1�1 S11AC 01,1 t V�nT A'c4 � 114N7•"'C S ip,.A+ d A(.1)
�IOVJ CA • fj ►ZJDA See note on back regarding River Basin rules
See additional notes/conditions on back
I AM AAARE Of STATdL17ES,CR LES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please initial)
hlr*07'7� r o
AgCnt plicant PRINTE ame Perm' Officer's P N FEDN (,[
Si ture"0jal read c nce statement on back of permit" Sig ature
App icatO Fee(s) Check N/Money Order Issuing Date Expir tion Date

;1+jjWASt4, KCAMA El DREDGE
DREDGE & FILL N9 91244 A B D
GENERAL PERMIT Previous permit
Date previous permit issued
Ohl
f New ❑Modification Aornplete Reissue ❑Partial Reissue
As authorized by the State of North C a,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC 114 .Q00 ❑Rules attached. General Permit Rules available at the following link:www.deq.nc.Yov/CAMArules
Applicant Name ICENDiUa WMITE Authorized Agent ENN6-r•r 0AKJIVE GoNSTRu.aTiw
Address 213 LAGu.niA LANE Project Location(County): ONSLOVV
City 3A0CSpNV I t t f State C. ZIP B S�tD Street Address/State Road/Lot#(s) 211 LA 61.tNA LAN V
Phone#(_)
Email Ot r_wJ j-k 2Of 3&O wNoo k.chm Subdivision LlysWVq SAV
City JA(.►Cspov)LUE ZIP �85'30
Affected 19 CW IKEW X PTA :g ES ❑PTS Adj.Wtr.Body I v E W 1S I Vf�EQ ,n!at-an/unk)
AEC(s): no❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body F_W T.IVY
ORW:yes PNA:IveSYno
Type of Project/Activity REPLACE 4S I of EXIAMA16 811ALKH£AD CQNJT9LkLT n►6W yS DOCKING FActUx rj WI114
FINGER e)98 AN b 10 K fin AT L I F�Mb_5)< 6nAT L-IF�T' (Scale: 1;20 )
Shoreline Length 45'
Access Length
Z� _ lv
Pier(dock)length 6' X 45 1 0
I �
Fixed Platform(s)
Floating Platform(s) / N(N� r)
Finger pier(s) 3 1-2 . 3,
...._.. - -
Total Platform area
•G
Groin length/# ✓
Ikhead Riprap length`�4.5 _ W
istance offshore.
_._
Breakwater/Sill
vl Oh Max distance/lengt
Basin,channel / `r
1�6
Cubic yards , - •� __._.. -.. ___..
,c O
Boat ramp
Boathouse 2i 13`n IV, 10'1N b6 '� OL�p�X pl—
Beach Bulld zing / r. pp
her N1&M, 6Q
YY I
vlal��c� Ll-��S
SAV observed: yes
Moratorium: n/a yes
Site Photos: es
i
Riparian Waiver Attached: no
A building permit/zoning permit may be required by:�TL A GOVN J k 1e
T�tl S(nad ;v---,c t = I(4 C� OL.k-�- ef�d ❑TAR/PAM/NEUSE/BUFFER(circle one)
Permit ConditionsU
S(4: 1)\Aeel • (wq ❑ 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)
r -i r' -C.
Agent or Applicant PRINTED Name Permi Officer's P NTED Na e
Z,�
Si ier!;*Iftag read compliance statement on back of permit** Sig ature
Application Feels) Check#/Money Order Issuing Date Expirkion 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 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 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+0LOAST'1hN❑CAMA ❑ DREDGE & FILL N9 91244 A B OD
1 GENERAL PERMIT Date Previous permit
Date previous permit issued
❑New ❑Modification [I Complete Reissue ❑Partial Reissue
�6D
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 SA NCAC u i I ❑Rules attached. ❑ General Permit Rules available at the following link:www.dgq.nc.gov/CAMArules
Applicant Name eL N WZ A W 1-1 n C Authorized Agent :r T T N I r + .+r:�,J R a�-7 AWAj
Address LAGunNA LANF- A' Project Location(County): !'1\)SLOy\J
City State iV.0 zip �),K590 Street Address/State Road/Lot#(s) 213 L../\(,UNA LANC
Phone#(_)
Email '�s_rl�+�� . k.(„wn Subdivision_LAGy&A ,A
City JACie--,JNV)LLC ZIP ;21
Affected ❑CW ❑EW EJ PTA 0 ES ❑PTS Adj.Wtr.Body J`t- �'�f1 I V Lr' d'nQmanlunk)
AEC(s): ❑IDEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal.Wtr.Body /V�_ by
ORW:yes/no PNA:yes/no
Type of Project/Activity Kt:PLfKE yS' n( E)L1STIA/6 Ski-KHEAC CUNSTRUCT nNL-W 4S ' ZL<_K+NG, FA U-auY WI'TJ!
FINGEf CICP,'` AN D 1 UK rc)A7 i rr 6Nb >K OL)AT I.—IFT (Scale; 1.20 �
Shoreline Length
Access Length --
Pier(dock)length X Li a
Fixed Platform(s) /
JQ
Floating Platform(s)
Finger piers)
Total Platform area I +
Groin length/# 4- O i
Bulkhead/Riprap length
Avg distance offshore f++__.. __ ..._ _......_.� _ + p, ............ ... _.._..._ _._ .._.... . . `.
Breakwater/Sill -�
i
Max distance/length
Basin,channel -I
Cubic yards �__. -_..
I
Boat ramp
Boathouse/Boatliftnow-
Beach Bulldozing 1 '�
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes>Cno)
A building permit/zoning permit may be required by: �n C��0 i��l r 't
ll L1 ❑TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions_ +L �+�i1 4'��+i1' Cl + �v��)ltC-{ — 1l�t'v(�4 C"}'
+ i (A -t-tl I .4 ❑ 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
"114.
Signature"Please read compliance statement on back of permit" F/1512tl
ture
U��S
Application Fee(s) Check#/Money Order Issuing Date Expir Lion 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 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

30*00ASr'1' ❑CAMA ❑ DREDGE & FILL NI? 91244 A B_ D
Previous permit _-
GENERAL PERMIT --4-1 ---'
Date previous permit issued =+ .
v .
❑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:
I SA NCAC F l ❑Rules attached. ❑ General Permit Rules available at the following link:www.dgq.nc.Yov/CAMArules
Applicant Name i Authorized Agent N
Address _ Project Location(County): L ii}V
City _ State ZIP �/li Street Address/State Road/Lot#(s) 1; L-AGoNA i.., VE
Phone#(_)
Email f „rri Subdivision \ "'VA -,Ay
City y v i t E ZIP
Affected ❑CW Q EW ❑PTA ES ❑PTS Adj.Wtr.Body ✓ c (natYman/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body 1�
ORW:yes/no PNA:yes/no
Type of Project/Activity _ L S7IN— l'o CT nl t W 4
t T- L_Ir'r (Scale: I. f U )
Shoreline Length
Access Length +Jr _ .. . I _ - --. _._ .._._._.....
Pier(dock)length r ,
i
Fixed Platform(s)
i
Floating Platform(s)
Finger pier(s) '
.........
Total Platform area i
Groin length/#
Bulkhead/Riprap length _r
Avg distance offshore - ._. ).._..... ..I.._. _... t�._..... .... L...... _. _._. _... . . -
Breakwater/Sill - �.-----
Max distance/length -
Basin,channel
- _.._
Cubic yards - I_
Boat ramp
Boathouse/Boatlift k. i`t ' I r t
Beach Bulldozing N. r,
Other
- - - -
. I
IN
t, 1
I s r
SAV observed: yes no
Moratorium: n/a yes no [IJE
Site Photos: yes no
Riparian Waiver Attached: yes no I '
A building permit/zoning permit may be required by:
Permit Conditions r( 1 (4;(j4 4 ❑ 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 Officer's PRINTED Name
Signature"Please read compliance statement on back of permit" Signature
(C (IiI .4
Application Feels) Check#/Money Order Issuing Date Expir lion 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 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 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 AUTNU IZATION FOR CAMA PERMIT APPLIC IAN
Name of Property Owner Requesting Permit: Lid CA ( �' c
Mailing Address, --A 13
Ja c.k,5 0�V111� 1�� &,57
Phone Number: (c-
Email Address: dr. whi e 100k. C-CM
I certify that I have authorized E Mnne-ff Mq4rLru &j)'4YC-k'br)
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ,�?X _ Pl e_� t�51 F) n�er
i ...,�..k.._ d...
at my property located at. rie CQG 66n , ( ,
in __ 51�CQ _County.
l furthermore certify that l 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:
Signature
Print or 'Type Name
Title
p�atfr
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FORM
CERriNiE MAlI� RETURN RECEIPT k CCU _IF-D or HAND DE IVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner,
Address of Property.
Mailing Address of Owner;
�k, com
Ownor'a email: C ri l e a a OLf� Owner's Phone#:
Agent's Name:,� :lljt �t�,J let'_n,[� ` � 1.�("I1LYrAqent Phon©#:
Agent's Email:
Aw-
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(j ottorn nottlon to be completedthe d n rt Owner)
\ I hereby cortify that I own property adjacent to the above referenced property,The Individual applying for this
permit has described to me, as shown on the attached drawing, the devniopment they are proposing. A
-•�'�l�`1(�` ,+lescrjpE:l�►a_4.CSa.,f��.1�9 wft ,cin �a�j4r�,s_rr�t t���roufd�ci witf��lis.���tc�s•
1- CP 6L DO NOT have objections to this proposal, I DO have objectionh to this proposal,
If y(_)W,has® obje`ctinns to what Is being prppasad, you must notify the N.C. Div Is*lan of Coastal
Management(DC" In writing within 90 days of receipt of this notice, Correspondence should be
frialled to 400 Commeme Ave.,Morehead City,NC 20557.DCM representatives can also be contacted
at(252) 808.2808. No response Is considered the same as no objection if you have been notified by
Cortiflod Mail.
WAIVER SECTION
1 I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
« be set\ groin t back a minimum
distance me
(thistdoesnot applyto bulkhe ads orriprap rev t ment), (If you w� riparian y
wish to waives the setback, you m�t altln
they appropriate blank below,)
I DO wish to waive sorne/all of the 15' setback
Slgnature�of Ad/aci�nt Ripa7rlan F'raperty Owner���~T �_
-OR-
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Propoity Owner: R-
f,
Typed/Printed name of ARPO:,. o&!z
Mailing Address of ARPO: efZ
ARPO's email: ARPO's Phone#:
Ivor Is valid for up to one year from ARPO's Signature"
ll//�� Revised,July 2021

N.C. [DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ORTIFIEU?MAIk• RETU N R,FCEif';,--.ECU "'ST -D Qr H ND C)ELIVE RY
(Top portion to be completed by owner or their agent)
Name of Property Owner: le n
Address of Property: r� La �nG�W e- 1 L'
Mailing Address of Owner'.w64
w.h o �look'cam
Owner's email: C o� � oc.r Owner's Phone#•
Agent's Name:.. 01,L d—r 1 li�'�S.rl Q l(-,�•�I�Agent Phone#: ����'�l o�17•-342 J
Agent's Email: _cr '�L.oy..ti!'� L-U _�:�L j_ffje',A
L�
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom otttton to be completed�y thp Adiac-ent Pronerty� Qw,�r)
I hereby certify that I own property adjacent to the above referenced property.The individual applying for this
permit has described to me, as shown an the attached drawing, the development they are proposing. L4
rl
NOT have objections to this proposal, I DO have objections to this proposal.
Jectlons to what is being prapasfad, you must notify the N.C. Division of Coastal
Management(VCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave.,Morehead City,NC 28557,DCM representatives can also be contacted
at(262) 808.2808. No response is considered the same as no objection if you have been notified by
Certified Malt
WAIVER SECTION
l I understand that any proposed pier,dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me
i�h®loes not apply to bulkheads or ripr4rement
s). (I ou wish to i the setback,you rnIgn
appropriate blank below,)
I DO wish to waive some/all of the 15'
f d/acent Riparian Property Owner ~�
_OR.
I do not wish to waive the 15'setback rnitial t blank)
Signature of Adjacent Riparian Property Owner:
�
Typed/Printed name of ARPO: 4�,��
l� (�
k Mailing Address of ARPO: LAt �b S �
�e J� ARPO's Q il: _ ARPO's Phone#:
"waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021

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�00AST414 9CAMA ❑ DREDGE & FILL NI? 91213 A B 0 D
GENERAL PERMIT Previous permit
�• � Date previous permit issued
��NINNew ❑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;
I5A NCAC 7N •l4�O f11JD j{ I DD0 Rules attached. X General Permit Rules available at the following link:mydgq,nc;gov/CAMBNuIos
��//
Applicant Name_116AlIAICa W 1TE Authorized Agent 6JVAL97r_ 11-JALINE CON3TLutT1a,1
Address, _R.t LAGtAyr, LANo Project Location(County):-- 0A1SL.oa
City Ah 00 V 1 C.1,k__State•- _N C. ZIP_,V'$540 Street Address/State Road/Lot#(s) 211 A .r A aA ysr -
Phone#(—)�._�
Emailf,yiL j�l��l'�(��iTook Cam u Subdivision S�n,_A Y_
City UCJ!u0NVIL&A ZIP 990
Affected CW EW [jPTA >§ES E]PT5 Ad),Wtr•Body_ N.C_RIy're —&an/unk)
AEC(s): OEA IHA UW F SPIMA PWS Closest Mal.Wtr.Body
ORW:yes(no PNA yes o
Type of Project/Activlty RCgL"r: y51 Di ex1STf0G, 014i1-XlljAb CN5iR+A4T )V4Jt 6Q' T14
YIW17RoRM FfN6ER PIt AND MK BOAT Ltaa7 (Scale: 1 ;a0
Shoreline Length
I Access Length "' _AI _. ..: I 1"1"11111115-
40N•} tilliliIV b I. - �•
' .. ..,
Pier(dock)length �OO
Fixed Platform(s) W x 10' -
9
P _..
Floating Platform(a)
Finger pler(s) 1X IS s AMb 30140 Lod
3' - �.. .
Total Platform area
Groin length/Ji
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin,channel _ v �. _-• I-T-
k Cubic yardsBoat rampBoathouse/Boatlift - - rBeach Bulldozingtov
Other ON6 Ulf A10*011¢1b
$AV observed: yes n
Moratorium: n/a yes n -••�- -`I!
Site Photos: no
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Riparian WalverAttached: es no .._ __I_. YJ...L_.
j A building permit/zoning permit may be required by; 9�JAGKSGyyILLL ANO ONSt-Ow Cw.NrY
Permit Conditions B_1Si <m4tb,_�GpnA1t �,v ?,4ME �eorDA1NT As �YHTIu& BurxHBA�. ❑TAR/PAM/NEUSE/BUFFER(circleone)
&4_'1MVktud all, Er LL 2 S'WORK C,94iihat EAW WASH oG See note on back regarding River Basin rules
P4tLKHGAO COCK MutiT (IQ;, 1.euwrEb AT LAST 3' ABaVE Sea additional notes/condlHonson back
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I A RE OF STATUTES CRC RULES AND COND ONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) 0
R104 4ONArT14AN 1�14UiS
AgeV P plicant PRINTED Name Permit Office' PRINTED Name
Signature"Please read comps ce s ment on back of permit"` Sign e
r� &00.00 )2/2lhU;t 1 4/)9/902- 4
Application Fee(s) Check N/Money Order Issuing Da a Exl5lratiA Date