57005_HUGHES, JERRY_20101209

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GENERAL PERMIT V �1 Previous permit #
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue 4) 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 t i. i j 1 '' l .(' G — I s G -
M Rules attached.
Applicant Name r Project Location: County
Address Street Address/ State Road/ Lot #(s) n
City State ZIP 7' N " nc
Phone # O Fax # ( )
Authorized Agent
El CW ❑ EW ❑ PTA
Affected
❑ OEA ❑ HHF ❑ IH
AEC(s):
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
❑ ES ❑ PTS
J UBA ❑ N/A
Crit.Hab, yes / no
Subdivision 1
City LIP --� 1 1
Phone # ( ) 512-11!2 River Basin � ,.1e dc, C
Adj. Wtr. Body 4 �' l ' T` t1� Mih nat a unkn
Closest Maj. Wtr. Body' ��' fA r
st.: C::ONE M MM::::::::::::::::::::MC:1
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Agent or Applicant Printed Name
;'
Permit Officer's Signature
Issuing Date Expiration Date
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check # Local Planningf urisdiction 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 [)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 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
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/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(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:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
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 08/09/06

Applicant: Jerry Hughes
Date: 12/9/10
Permit #: 57005C
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Shoreline
Dredge ❑ Fill ❑ Both [I Other O
110
.
110
High Ground
Dredge O Fill ❑ Both ❑ Other ❑
1500
1500
Open Water
Dredge ❑ Fill ❑ Both ❑ Other El
208
208
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02103/10

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORINGPILINGSIBOATLIFTBOATHOU.SE)
I hereby certify that I own property adjacent to VP-XP- y Z45he.r is
(Name of Property Owner)
property located at (0 3 Ar4-m m o e-L RvA-�- t-c)4", H ,
(Lot, Block, Road, etc.)
onyAO Wcs-� mqv/k /34x , in l ke,gs- L� tea/ , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 3 3 6- 3 1:1. -11 1 Z-Mailing Address: �T&5 7 !i? neS 4A, S 4-
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
S`,e C�- - �/-/,g C-/,eC�
(Information for Property Owner Applying
for Permit)
_76s % mn,47a/U c:k
Mailing Address
1R1Av14,y N, C, a 7370
City/State/Zip
-------------------------------------------------------
(Riparian Pro erty Owner Information)
1
Signature
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Print or Type Name
36 - 3/a - /// rat _1o7� 1690
elephone Number Telephone Number
Si ature Late Date

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
-11
I hereby certify that I own property adjacent to ✓63egy hiV- 9 is
(Name of Property Owner)
property located at t> 3c/ 61.4 1 c'lc'
(Lot, Block, Road, etc.)
on L� �' L(%C,S-,L my a A/g4a' , in -Z'-,^ .,4,Vd , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:.33&- 3 ! a - ! / /2 Mailing Address: /nDR � jv, S,L
He has described to me, as shown below; the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
tJ�ee /x,
(Information for Property Owner Applying
for Permit)
Mailing Address If
City/State/Zip
lephone Number
ignare Date
-----------------------------------------------------------
(Riparian Property Owner Information)
Signature
Print or Type Name
252--)2S-�-7-76
Telephone Number
2.5/1 !c,
Date

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JERRY LYNN HUGHES 09926
RUTH G HUGHES PH. 336-431-1556 66-112/531
NCDL 3429490 NCDL 2261100
5657 MORGAN ST. PO BOX 61
TRINITY, NC 27370
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