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`AMA / ❑DREDGE & FILL ;jg A B jC,+ D
WaEN ERAL PERMIT Previous permit #
ew ❑Modification ` ❑Complete Reissue I] Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources^
and the Coastal Resour es Commission in aAi area of environmental concern pursuant to I SA NCAC
w ules attached.
w. 4
Applicant Name flf' AU) Project Location: County" yet`"�`""'
bf
Address i !Sox Street Address/ State Road/ Lot #(s)
A # .>
City t-+ 4" State ZIP L,_ �' a + 6,,
Phone # (c `°' ).'�l E_Mail Subdivision
Authorized Agent
Affected �
Plcw
AEC(s): ❑ OEA
❑ PWs
,lff `W _E I' I A ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ USA ❑ N/A
ORW: yes /% no PNA (" yes/ no
Type -of Project/ Activity fy b t
Pier (dock) length '7 0, / '', %)
Fixed Platform(s) l �+
l.
Floating Platform(s)
Finger pier(s)
Groin length
number w
Bulkhead/ Riprap length
avg distance offshore "
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV. not sure
yes
no
Moratorium: n/a
yes
o
Photos:
yes
no
Waiver Attached:
yes
a
A building permit may be required by:
City 'x d ,t to ZIP r r
d
Phone # ( ) River Basin., rjP�w
Adj. Wtr. Body ' d "",rr,. �" a man unkn
Closest Maj. Wtr. Body___ ;' el
X I 1444 .14?/�
(Scale: ,,l )
3 ;s
i . ❑ See note on back regarding River Basin rules.
WIN
( Note Local Planning Jurisdiction).
Notes/ Special Conditions
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4
-Agent r A 01' t Pr' ted N �
f
Permit 0 rce
Pr'nted Name
v"�,
P Si naure' s Pleasereadcompliance statementonbackof erm?it
re Signatu``
!! Y
y Application Fee(s)
Issuin Date
Check# .. g
iratio Date
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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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules 0 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 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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: 252-247-3330
(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: 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/14
�arAA / ❑ DREDGE & FILL 4r
a� A gCC/'D
LeENERAL PERMIT Previous Permit
ew ❑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 Resour es Commission in area of environmental concern pursuant to 15A NCAC
" 94R`'les attached.
Applicant NameProject Location: County &`V 1-4Address QK Af Street Address/ State Road/ Lotf#(s)
City i State_,,�Zl P
Phone #E-Mail Subdivision
Authorized Agent City r 13 C, -I ZIP
Affected ow 4i PtA ❑ ES ❑ PTS Phone # (_) River Basin , e� ay-
❑ OEA ❑ HHF p IH ❑ USA ❑ N/A aa
AEC(s): Adj. Wtr. Body ej a . s, (vim Co- f� man unkn
❑ PWS:
Closest Ma J. Wtr. Body re
ORW. yes no PNA yes / no 1y
Type of Project/ Activity { 1 a t X / 6 to ✓°"
Pier (dock) length Y e- ILIV
Fixed Platforms)
Floating Platform(s)
Finger pier(s) .»
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 .
SAV: not sure yes (o
(Scale: °'j` )
1■®��! WON �!■�i■�111pi�li ,�r�i■I■��1�®®
mom
i®®®
ME®®
Moratorium: n/a yes o
Photos: yes n — — -- --
Waiver Attached: yes no ' L I
A building permit may be required by: r I ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
n
' . "I hereby certify that. I own property adjacent to ' Koddiyr A KS�n rl 's
r — (Name of Property Owner)
y'kio
on (% t kt.% m Ctaot,c , in k; SVrti , N.C..
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc ti n.
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)
( e#,%%a1JP Ooc L 1V {3d SAN►d DoAdo C1oN0 AS JOUST104P 000C
1`t.(l►T M�2 �dJN TFtdRd l�O�i 24 YR.T. T' W+ad dx OrNO To
8 / x t 4,r'1 A 4 oer do d , WTI /� down S 11 pMT Fddr% ?het SHovtn
Aid FAO„►.` 2 � �vdrl.LAKO '70 rtkd SiOstw�tK 'i'►t�rT �NdS
hT .mod $�.Nd�►�►i �Qd�c�t�
4� W,O4&
F*xPAWT IV d'"S'"t s
DECEIVED
MAtrrs�t w tcusTt►N CROLIc MAY 0
-g
61015
a
pCM-mHt3 CIN
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. RECEIVED
I do not wish to waive the 15' setback requirement. MAY 2 2 1015
(Prop Owner Bn ormation)
Sign tune
KoddRr 6. A -a -my
Print or Type Name
P. o. dew 787
Mailing Address
of 4.4.# mri f A C. Usft
City/StatelZipp
2S2 - 749- $tot
TelA
hone Number
Ay 4 2oIS-
Date
(Adjacent Propert ner Information)
517
/1'n dcSL.ICAI
CIzip
ityMl-
Telephone
Ry No%
Date
(Revised 611812012)
7'
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
`I hereby certify that. I own property adjacent to Ro0lt T C3. A 4 S'h el _'s
(Uame of Property Owner)
on W cc,c.t s-oK ICddK , N.C.
(11tlaterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
Tkit
I have objections to this proposal.
DESCRIPTION AND
DRAWING OF PROPOSED DEVELOPMENT
(individual proposing develop
must fill In description below or attach a site drawing)
R�PAtt O fJ0 bL 3Ar+C. aor►�?Msto�rs �.s dX13'DW6 Ooc'c
1'�thc W►is �bddH-r►�dad Pik ?.� �Rs . �f'.� Boa
$'x/L ' Tdd APPRox 4A »�rGcy 8rl okt Lo
n
ToTAc. pJsT,»�►cer� Pr.�s 43' ovd�„�,D1.�rd "ta �
StOetwl►�.K/t3�caca+�Rar tAfNTtc�+c t=oorPR�NT
_S ISAW ALK I _ �!-' whAd
YARD �� . iARSM RECEIVED
�
MAY 0 61015
DGM-MHt7 CITY
61-4
WAIVER SECTION
t�x�rutNdrrro, TO
SNo4df_tW tC
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 trust initial the appropriate blank below.) RECEIVED
� I do wish to waive the 15' setback requirement. MAY 22 1p�5
I do not wish to waive the 15' setback requirement.
ation)
Sign tune
�oB�FttT tg. ,4 � sTrry
Print�tr Type�vame
l� O. 13o K ?f ?
Mailing Address
W Icc tsro�ttN,C. 28S8S
City/State/Zip
252-?LQ-i3to/
Telephone Number
n. .
(Adjacent Property Owner Information).
Signature �
`e-
Print or T pe Name
Mailing Address�
7oi✓�?�,5��
City/State2ip
Asa - 9a 9- 3a8 /
Telephone Number
Date
(Revised 6/98/2012)
T
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Page 1 of 1
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RECEIVED
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