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MCAMA / n'DREDGE & FILL
GENERAL PERMIT
Previous permit #
New ❑Modification ❑Complete 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
Project Location: County Nai; 11i
Addressi i n 1/ i t' �,_y t i 41i1 �C �(i(t .
Street Address/ State Road/ Lot #(s)
i
!�iZIP
City l ''�i t I`� 1 1 1 1 '((! i j State tka
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Phone # ( ;I ,,) q 14- 45Fax # ( )
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Subdivision i' �_,ki
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Authorized Agent d
s 11 '1. O f' i' l;, i ►
City 1�1i _ZIP
EJ CW L7 EW � PTA ❑ ES ❑ PTS
Phone # (' j 1 River Basin
Affected
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA El N/A
kk
Adj. Wtr. Body 1`
C l nat an unkn
❑ PWS: ❑ FC:
�
Closest Maj. Wtr. Body—, l
ORW: yes / no PNA yes / no Crit.Hab, yes / no
Type of Project/ Activity
!'
r ..f { r �`T__
(Scale:
--
on back regarding River Basin rules.
Pier (dock) length
Platform(s)
Finger
Groin
Bulkhead/
Basin
Boat
Boat
Beach
Other
Shoreline
SAV:
Sand
Moratorium:
Photos:
Waiver Attached. yes 1 no
A building permit may be required
Notes/ Special Conditions _yf
❑ See note
J'� N t i.
by:
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length
number
Riprap length
av distance offshore�rji
max distance offshore
tt
channel �.'�� 1 ' X�-
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1
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cubic yards
ramp
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Agent or Applicant Printed Name c Permit Officer's $fgnature
�jcl
Signature "Please read compliance statement on back of permit" Iss ng D{{ � ExpirAtion Date
Application Feels) Check# Local Planninglunsdiction 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
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythatthis project is consistentwith 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 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ I-888-4RCOAST
Location: Fax: 252-247-3330
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:919-733-1495
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06