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L,1CAMA / [-)*DREDGE & FILL N° 78561 CA B C D
GENERAL PERMIT Previous permit#
i JNew ❑Modification El Complete Reissue El 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 j7
�+ ! m Rules attached.
Applicant Name C�� t` $ �` /�t +�n�e�a j6y5AS, 4-1 Project Location: County y a
Address e e V a J e �d 5 .D c ; ►1e Street Address/ State Road/ Lot #(s) L "� 3
City L U S 4 � State AV ZIP 2. ° 4 (PS% L) � -J
Phone # ( !') G - �� a /E_Mail G h 14�% Mo ,;1 U; KA✓Kubdivision }2 iJ c u n -S� > (rPS S-P
Authorized Agent Q a o 4 ✓� City A) 5 S ff a ac( ZIP Z 7 =�
❑ CW �fW A DES ITS Phone # ( ) River Basin
Affected ❑ OEA "❑ HHF ❑ IH ❑ URA ❑ WA
AEC(s): Adj. Wtr. Body (nat /man /unkn)
❑ PWS:
yes / no� Closest Maj. Wtr. Body
ORW: yes / no PNA
Type of Project/ Activity
Pier (dock) length _--
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) `
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore .i
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: (yes- ) n
Waiver Attached: yes no
1 (� •1 Dow \ � Qf-�
(Scale:
A building permit may be required by: �J c* 5 S X a el ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) I
Notes/ Special Conditions i_ S 4� l r, 19 E24 Q C' - y^ "r, 44
Agent or ed Name Permit Officer's Printed Name
Signature 4 P e rt*tompliance statement on back of permit
Application Fee(s) Check #
Si , u
7J� -2/�"
Issuing Date Expiration Date
Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific 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 I) 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 or certified mail return receipt has been obtained from the adjacent riparian
landowner(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 ❑ Other:
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. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17
q q 0 L AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: /r'�� 111
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized _ Agent /&ontractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for
the following proposed development: Z-
So tw n ..S
------------
at my property located at
64
fir( t
in QC,/, t-e-- County.
i furthermore certify that i am authorized to grant, and do in�feet grant permission to
heir
Division of Coastal Management staff, the Lora' Permit/offic ing ���rmr t pna agents
s t to enter
on the aforementioned lands in connection
permit application.
r Property Owner Information:
Signatt
3� S 1�
L Print r Type Namo
00
TWO
Date
1
This certification is valid through -----
4 MRUA1t S JONM R.. PL.S, CEP+,FY THAT V111)ER MY DIRECTION AND SUPERWSI061 11115 I`, Al y,r„ ^04AA7! rpCko
Alt ACTUAL FIELD LAND SUR%XY mA,)E BY WE FR,1M INFORMATION ITS REFERENCED HEREON, A110 TTIA7 It'( PA-10 Cr
PREC19ON IS 1-JO.Ow •. "TNESS 1,1v HAND AND 'JAL THIS ------- DAY Of
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MAP ROOK 4, PAGE 92
TOWN OF NAGS HEAD, DARE COUNTY, NORTH CAROLINA
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DIVISION OF COASTAL MA14AGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to C� r 1
(Tame of Property 0,4MISr)
%/ / o00 es
property located at
(Project Site: Address, Lot Bloc/ , Road, etc.)
on h L OU n OL , in T� S f !P . i�I_C..
(Waterbody) (City/Town and/or County)
Agent's Name k Y- ►' Mailing Address: 000 ���+� a
Agent's phone #: w1S T L�
He/She has described to me as shown below the development he/she is proposing at that Icc2-d r,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(frali' "rsiirget�ettit -— p sTa desc lion beorar>at;sa_c7_fit
t'tiXai
9c4ik�ica
fjyou have objections to what is being proposed, you must notify the Division of Coastal �blara;� er.:a,t
(DCM) In writing within 10 days of receipt of this notice. Correspondence should be rnailed it, 401 S
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at ( 6Z) 21: -
3901 No response is considered the same as no objection if you have been notified by Ce&&led Mail
(Property Owner Information)
Signature
tint or T ame
Po �o�
Mailing Address
�c: �v Ala � Z-711 y9
City/Sta e/Zip
2s'z w-
Telephon)e�Nurmber/Email Ad/dress
�pi / r+ n �jy •�U eGh- a1 T !a l . G 07YN
Z -
(Adja e t�8
wner Information)
Signature*
Print or Type Nance
l3J�s. horn
�c' r��i
Mailing Address
`1-0
C.�i � 1 1
Citylstate/Zip
Telephone Number/Email Address
H
DIVISION OF COASTAL MANAGIE MENT
ADJACENT RIPARIAN PROPERTY 9-WN9R NOTIFICATION FORM
e`ERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I , mtt, that I O%kn property adjacent to 's
(Name of Props Owns?)
Je<' Dr- Lo4 -1
(Project Site: Address, Lot, Block, Road, etc.)
in N-C.
(W-m-body) (C /Town andlor County)
rya s ma-,?e
Mailing Address: P 0 At5-I'l 9 0
/ T
3sSty :a s -: zk :� o me 3s Shm%n bellowI;a the development 'she is preposi1 at that lac aticn,
a> � 3'ave .v ,b;p6z:�. onz to the proposal.
_ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
- .NAME�;�e
�•
1L g� L M f n4 of h "L G j% OIL i ✓ p
Y�:1'.ai•e objecdow to »fiat is being p *x)seA You mustnotiiydue DiWafon odCoastsi,LRsrs rrrerr;
T-CW ;n Hein 10 days of receipt of dit notice. ConespondW" slwu/d he marled to 441-1 S
ter St, -" 3ih�, Uaabeth City, Na 27909. DCU ►sprssentadm can also be c ontacmd at (26.., j 2C�F
3-AM. No response is considered the same as no Wection if You have bean notified by Centittedyal
(Property Owner Information)
I t rur&
PC
-)Z Z-
t_ !
(Adjacent Property Owner Information)
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