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' 06CAMA
GENERAL PERMIT
❑New ❑Modification omplete Reissue XPartial Reissue
As authorized by the State of North Carolina, Department of Environment and Na
and the Coastal Resources Commission in an area of environmental concern pursu
Applicant Name J !� (:. (_,xke.,
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Address ' '. yb,. '- I 1 f i :`; 3 :. 1, 0't r I
City r) ` +o t- State J\1 (,-~ZIP
Phone #)' �'" : E-Mail w ,.
Authorized At.gent !l r+' ��
Affected El CVN PTA Li ES ElPTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ElUBA ❑ N/A
ElPWS:
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`Agen or Ap t Printed Name
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Signature Please read compliance statement on back of permit`
plicationFee(s) Check#
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Previous permit #" `
Date previous permit issued
tural Resources,
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ant to 15A NCAC
-[!! ulesattached.
Project Location:
County
Street Address/ State Road/ Lot #(s);,
S
Subdivision
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City,
,�.
ZIP
Phone # ( )
River Basin
Adj. Mr. Body
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`4- 4µ f ': t (nat /if " /unkn)
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Permit Officer's Printed Name fti
Expiration
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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 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, certifythat this project is consistentwith 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 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
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
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