Aiken, III, Hovey E.

QCAMA k. -DREDGE & FILL
Y-Y11 NO 67591 A B C D
GENERAL P E R M M I Previous permit #
PlNew ElModification ElComplete Reissue 0 Partial Reissue Date p permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources Tious
and the Coastal Resources Commission in an area of environmental -concern pursuant to I SA NCAC
Rules attachedl
Applicant Name Project Location: County
Address— i Street Address/ State Road/ Lot #(s)
City Ai State 'I, Zip tom
Phone#
Authorized Agent
El Cw
Affected
a] EW LtJ'V �
\TA
AEC(s): 0 OEA
0 HHF 01H
11 Pws-
ORW: yes/
PNA yes /�i
Type of Project/ Activity I
Pier (dock) length
Fixed PlAtform(s)
Floating Platform(s)"170
Finger pler(s).
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel ---
cubic yards"--'
ijT;�
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAM not sure
yes ,no
Moratorium: n/a
yes (no
Photos:
yes,' no
Waiver Attached:
yes no.
0 ES El PTS
0 USA 0 N/A
0
Subdivision,
ZIP
QPhone # /River Basin,
Adj. Wtr. Body
bat /man lunkn)
Closest Maj. Wt1r. Body
(Scale: I —'-
A building permit may be required by: 4-1 See note on back regarding River Basin rules.
Note Local Planning Jurisdictions J
Notes/ $peqijl Conditi6ns x,(,
J
V.
Agent or, Applicant Printed Name
"R
Signat , ure.. "Please read compliance sementonbackof permit"
Application Fee(s)Check #.

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:
0 Tar- Pamlico River Basin Buffer Rules Other:
0 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-8884RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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)
(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 - South of New River Inlet -
and Pender Counties)
http://www. nccoastalmanagement. net/
Revised 08/27/ 14

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hetehy Fortify that I nn property adjacent to t
r`o f erty 0wn r}
property located at
an rasa, l ot, k Read, +�
..._.._M..._..._.__- __._......_................._....................W ... .
JWaterbody} (City/Town and/or County)
Il`he appilc as described to me, as shown below, the development proposed at the above
locati
i have no objection to this ar oposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
findividual proposing development must fill In description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring tailings, breakwater, boathouse, lift, or grain 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 (equirement.
"rop<� t w--, information)
st re
ling Adrs f�
Mty % 11
Property 4 Inforr`rtatioA)
1. `f. 6*)
Mallrng A
City/St te21p
1"r'leph , �.-
v�r�
RECEIVED
g6 2 4 2015
(Revised 619WO12)

homby cailify flh,.al own pf aperty adfaceAl I o
pmpemly 31
Uddrv*s, L
A
(Wate rbod Y.J,
IMM
Thlicam ",� 0oscnbed 16 rf'� 4s, thowri uelow, it*, el me propose-d of t* above
tsavv r1oabjOcU,,m to ifrmc proposal
! have MIP,040ftS 1�0 thfopo-%al
DESCRIPTION ANDIO, R DRAWING OF MOPOSED DEVELOPMENT
00 1" d0"OP00" b *,shv drmwfng)
I
I do wish to wa6,uf,.t tho i 5!sstbaok requi re—ment
t do not wish to waive the 15' setbaCk f eqLJI rement
(P-roperty
Owner Informatiort) .00 owrl'a ion
,
ToMphono Jvunftr AUG: 2 4 2015
Dam
(Poukg od 60 Ml 12).
cw TkPe Na
4k
IV,
- 5 A5,5A- RECEIVED
WAIVER SECTION
iu-noerslandthal a Oieu dqtkImanng t�ngs, breakwatef� boa"Ut lift: or ofoln mqst be 6el
P
back a mintm-um distan"ce Of 15; from my area of ripation ar-r-ass untass warved by me (If you
wish to waive I" Set back � you must irdtj at the epra :kate Wank bcaw
P Pt

AGENT
AUTHORIZATION
Sk FORM
Date V//�—
Name
A
crfiy that 1 have authorized (ageing � to act Orr mks
beha If, for the pit rtr e of upp kving fair a nd obtaining sill CA, MA Perm its mcmary to
Wdall or caustruel (activity)
t (my property, loco d ate
This 18 valid ttrr u (date)
3
4
42P-uls
Oate
RECEIVED
AUG 2 41015
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