61126_BARTLETT, BILL_20121121

DICAMA / 13 DREDGE & FILL
GENERAL PERMIT
ZNew ❑Modification -'Complete Reissue DPartial Reissue
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
`-/ No.
Previous permit #
Date previous permit issued
61126
Rules attached.
Applicant Name Project Location: County _- <
Address
City _
Phone #
Authorized Agent
Affected 1�] Cw
AEC(s): F' OEA
J PWS:
ORW: yes / no
State ZIP
Fax #--
EW a PTA
HHF ❑ IH
I FC:
PNA yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
Groin length
number_ --
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards___
Boat ramp
Boathouse/ Boatlift- —
Beach Bulldozing
Other
Shoreline Length
% t.
SAV: not sure
yes
no
Sandbags: not sure
yes
no
Moratorium: n/a
yes
no
Photos:
yes
no
Waiver Attached:
yes
no
U ES C i PTS
❑ UBA N/A
Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
AJ6
Subdivision
City r ' , ZIP_
Phone # ( ) River Basin
Adj. Wtr. Body E. '� (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: , )
—--
l--
101
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HIT
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 #
CI See note on back regarding River Basin rules.
I t,
Permit Officer's Signatures'
Issuing Date Expiration Date
a
Local Planning Jurisdiction 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 t,as 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/ 1-888-4RCOAST
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)

THE YARD BARBER, INC.
P.O. BOX 4562
EMERALD ISLE, NC 28594
PAY �\ .F (6� `�
}-{�j
TO THE
ORDER OF
3427
66.1246/531
noTG t � :';�`� i
DOLLARS
' Sauk
}4 Cape Cai tenet, NC 28584
14
FOR _ _ - - -- - --— -- _ _
i+&C3 0 27111 1:05311 24661: 00 10 1 L3911'
dY ''',wax M',p�^��, - : Y �,.�
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:1/13/2012 11:49 252^927743 ACCaunting_Un11Tn1Te0 #3073 P.002/002
AN ENT RI1R1>.i7JAN PRC) Y R"i Y AtA1 M.FR .9TATr± BAIT
I horcby csrtPfy that I Mnm prnperty adjacent to CJl 4�
(A1a v ! !'�ro�oorstij� Cb+rcy�ar}
prC.)Qg: cy iowtod at � ': P016A LSct + 1Vor�
(Address, Lot, gIook, Road, ate.)
on _Gt,
(Waterbody) (Ci'yrfow9n andtor C nty)
The tspplicacarfias described to me, as shown below, the development proposed at the above
ttinn
I hp%/e nn objection to this prnpasal.
1 have objections to this proposal.
MOSCRIPTION,AND/OR DRAWING OF PROPOSED UF-Y$L.OPMMN7
(Individualproposing development must fill in description below or attach a site drawing)
5g7.wa (J k, v-\ �fC)A-�'
in.c�J � w ci.(, t
WAIVE"MCTION
I t,lnderatand that a pier, dock, mooring pilings, braakwator, boathounA, lift, or groin must be set
1. c%*le a. .r,inimwrn Cl:�twn�• of 9 frair rmy aroa of riNr.a� lui i uvvvuv urlluvL wuivv6l Uy mu. (:T you
wi,sh11 to waive the setback, you must initial the appropriate blank below.)
Y� I do wish to waive the 15' aetbaok requirement,
11 I do not wish to -Ai— th- 1.P rntbn,%,,k requirement.
(Property Owner Information)
4 "gn tur
Printor ypo N me n
ail' lAdarals /tit /.
7 1�is —
it /cfaln/7i/?
TPIRphnne Number
=� rr--
Daa
Propedy Owner Information)
signatu
Print or Type AJAme
Telephona Nu bar
Dare
(Revised ar-i &2o 12)

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ B1 11 �Ckf+ I e, E-1 s
l�S (�1r(A50V1 � _(Name of Property C� Owner)
property located at _
(Address, Lot, Block, Road, etc.
on o ",S ttr , in ____al.tft Cow,
(Waterbody) (City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the alcove
loc ti n.
I have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
vl'vlc/L �eawo'(( (� d�o�% o-� eytiJ Yt� Wo-[l
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Prop rty Owner ormation)
tg ature Sig tune r
Print or T ppjName Print or Ty Name
ai to Addre s L g ddreqa
City/State/Zip2a,__s citylstatevzipp
Telephone Number -Tleph e Numb
Date Dat
(Revised 611812012)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date // �— 10L
Name of Property Owner Applying for Permit:
Mailing Address:
Iloq A,ol'tro,
r.
9G
I certify that I have authorized (agent) U PP ILA r(I Zj to act on my
behalf, for the purpose of applying for and obtaining all LAMArmits necessary to
install or construct (activity) 0� V I A y 1 S ea (0 CO1 I I
at (my property located at) I ��l ',� r I ea c, a"t r � V
This certification is valid thru (date) J 3 r b c)) � .
zj,� IL, 11,� �/- -L--
Property Owner Signature Date

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