60347_EVA PROPERTIES_20120717

1i —L�CAMA/ -DREDGE & FILL NO. 60347
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
n Rules attached.
Applicant Name C 1%A >r
Addressy r�
City i J� 1 n,..'+r, State ��C zip
Phone # ( )_! . 1Ci Fax # (�)
Authorized Agent
Affected CW _, EW 1 PTA :�i ES PTS
AEC(s): OEA HHF IH ❑ USA 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/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boatli N.
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Sandbags: not sure y'es no
Moratorium: n/a yes o
Photos: yes no
Waiver Attached: ' yd� no �--�
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "Please read complianceP'statement on back of permit"
r,
Application Fee(s) Check #
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City F-�r�, _ rt) L ZIP _`;`
Phone # (y -) - (� j �1 River Basin
Adj. Wtr. Body t}c'vG _ 'C r..�C+ (nat man /unkn
Closest Maj. Wtr. Body
(Scale: j G V ` )
E See note on back regarding River Basin rules.
PermitQfficer s Slilat?tire i
Z,
Issuingliatel Expi tion Mate
Local Planningjurisdiction Rover File Name

y
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:
IJ 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City. Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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,
Ons(ow -below New River Inlet- and
Pender Counties)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that i own property adjacent toj,�Cs
/ (game of Property Qlivner)
property located at �d LZ _ �G�GlitC( ,d/' "C/ej
(Address, Lot, Block, Road, etc,)
on A00 tie s in _ , N.C.
(`)Valerb< Jy) (CitylTown ,andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
! have no objection to this proposal.
I 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)
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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.)
1 do wish to waive the 15' setback requirement.
! do not wish to waive the 15' setback requirement.
(Property Owner Informa'ti/on) ( lace IProperty
.Y� /l / v — _ _ A
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
Signature
Print or Type flame
(Revised 611812012)

ADJACENT RIPARJAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent tol�k,4�i''`E�5" �� /'/L8St�a'zl� 's
,/� (N�,r�ae of Property Owner)
located at _2�_Z Z S m (//^i`!i`p
(Address, Lot, Block, Road, etc,)
_16Q^ _ in I N.C.
U (Waterbody) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
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)
/O XL 0
X•y V&-k
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 7towavethe 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 Informa 'on)
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Signat e
Pri o r rype,Q,lame
M e ing Addres
City Stat i
Telephone Number
Date 0 7
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(Adjacent Pr perty Owner Information)
Sig ur e
Print or Type Name
31f LncLL4,5,07— 'v"�
Maili Address
Li r1. c :2a
City/Stat�p
q 19 - 73 Lt 2 -- (' 2-
Telephone Number
Date
(Revised 611812012)

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