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/ID —CAMA / I DREDGE & FILL J N° 77844 A B C
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GENERAL PERMIT Previous permit#
��--= UNew ❑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 0 7- ' L S D CD .
❑Rules attached.
Applicant Name I~ut,)./4 It r\o `.t_i .. .i y c.✓ Project Location: County ` cr v".S— r ...1(.--_
Address LA!,` 1 NJ 04- .,A 511 F. 2 Street Address/State Road/Lot#(s) 7'7- SSc., 1 ,/,c r
City 0c., st--c., State-) /V% ZIP 2S 3 `� i 1
Phone#(1611 5'I J G.,A,,y E-Mail Te r.,A,.. v'' ' .@u,,I. c Q'`' Subdivision /�
Authorized Agent ��-� T�1 4 G q s l i City Oc.. c (S I.< (�e ,, , h ZIP l `( (0 7
Affected 2 CW o EW &PTA ❑ES ❑PTS Phone# ( ) River Basin ( h ....--
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body ,f , ,ts Cr-t (.1nan /unkn)
0 PWS: /I
ORW: yes K_no_. PNA yes / Closest Maj.Wtr. Body A I (G— h, ,-^,
1-
Type of Project/Activity _k VA., ,k ,\ InQk I, l -< .- `` (\. , ., - , ,I , ii 1-z.) r'e w
�. , f h, 'X S h '� c���-, T \J (Scale: N) J
Pier(dock)length j 'i`i '
Fixed Platform(s) l�' i
Floating Platform(s) 'I U I I
i
i
Finger pier(s) { f _�..--
Groin length ! 1 /�, ^ �
number U 1 I t
Bulkhead/Riprap length
avg distance offshore S
max distance offshore 1 t5 s eye` i-�
Basin,channel F
i
cubic yards , b ' 1
Boat ramp , � !"* I
Boathouse/Boatlift 1 ._! ._— �_. -4.__.....1...._..__.
i i
V
— �� ,
Beach Bulldozing
r Wii
ice` C,r,/ r '
Other I ��. ri c', c.) 't , .
4 �
.. �!\W , , ,
, . : New {
a el`
Shoreline Length ^ co Ii Z J `
SAV: not sure yes no tI c•., N ve✓.t I . --cam'h,ram_ •CSC G�I 1 S irk,
Moratorium: n/a yes F+,.i• 1 p it ra r , 0 }
1 P
� I
...._
Photos: yes _ _. I �
Waiver Attached: yes I i Li-1 A .r of O'.
A building permit may be required by: ` ,'cI� 6 C4 c ► ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions r,r L,...,` r, 1,1 A
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Agent or Applicant Printed Name Permital cer's Pnn Name
v -� _ jam
Signature **Please read compliance statement on back of permit** Signature
t� A NIA II/ 5120-zo 2 13 ?02/
Application Fee(s) Check# Issuing Date Ex irati n 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(910-796-72 15)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: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: ! � /t/h1.F v‘i l@3
C-44w L.6$7 r (it/ 2 (174
Phone Number: 30t11l �014
Email Address: —'" N r is 6- (T G- + Co '
I certify that I have authorized Carolina Construction
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ��, ,(_..L
at my property located at 47 ;P J
in ZA}N County.
I furthermore certify that 1 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 I ormation:
Signature
Print or Type Name
Title
4211_3_1213_
Date
This certification is valid through I I

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CAMA!0 DREDGE!•RLL iO 77844 a c C'
ENERAL PERMIT permit s
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Affected
AEC(s): cam❑PrM� °ittf ❑INo um , WA _ S_ ,A,j.Wm$odr .• J e..Its
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Weed dActivier tDkl4 Pu(LI CYet.jL£,.., rb Ixi �"L`s '..
Her(dadr4lrarr�A 5'
sow rr_eron,�(� ! 1 - _ I
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A building permit tray be regrind by: 002.41. WA.: a1"‘ . 0 See nose on beck reprdYle River Bain nrn.
(Noose Lod Plwdng lr■ Pen)
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