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j GENERAL PERMIT �rr'a� Previous permit #
L:New L_-1Modification LJComplete Reissue Partial Reissue , / Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑Rules attached.
Applicant Name
Address i
City State."WIC
Phone # (_) Fax # O
Authorized Agent +_ ,i ;}�.. } �• ,;'
Affected CW f [EW 4 PTA ❑ ES ❑ PTS
AEC(s): 1 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
_ PWS: ❑ FC:
ORW: yes / no PNA yes / no ; Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length -
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel
cubic yards_ —
Boat ramp
Boathouse/ Boatlift_ a
Beach Bulldozing
Other
r
Shoreline Length
SAM riot sure yes no
Sandbags: not sure yes rho" t�r
Moratorium: n/a yes no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City-- ZIP
Phone # O River Basin r
Adj. Wtr. Body r,;y.,_/, 1 (nat /man /unkn)
Closest Maj. Wtr. Body _ - l • ,
Photos: yes no
Waiver Attached: yes no , _-
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name,
Signature "Please read compliance statement on back of permit **
Application Fee(s) Check #
lip
(Scale: K, .4 cr"
- --- - -
Oij
See note on back regarding River Basin rules.
Permit Officer's Signature .. , t "� 2'LC./� f i4rr'• ..1y'�' r � +.f-..� j�- _
Issuing Date Expiration Date
Z' x
Local Planningjurisdiction -- Rover File Name

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 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 or certified mail return receipt has been obtained from the adjacent riparian
landowners). _
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules J 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 Quality. Contact the Division of Water Quality 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
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/OS