Bassett, Earl Clorence

PVC.AMA / 0 DREDGE & FILL
67499 A B C _ D
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 I SA NCAC / �/ . 0 .
r�
I G 1't'�C Cf7
Applicant Name L.� Air �J
Q�les attac ed.
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
/
City. rf1S�^ State IV6 ZIP
Phone # �� �I. '1� -�U2 .
(—) I E-M/a�il
Subdivision
))I
-Authorized Agent t l % �' �' / 61l C, k
City ''►'t r��c J r' ZIP
Affected . „E]PTA -�Qtrs ❑PTS
-
Phone # (_) 'ver Basin `t� i''� f f Vi41
El OEA ❑ HHF ❑ IH . ❑ UBA ❑ N/A
AEC(s): ❑ PWS
Ad' Wtr. Bod JD 1, F . f ^ �,� .
J• y Ana man unkh
ORW: .yes no PNA yes no
Closest Maj. Wtr. Body U �o�

I
/•❑ DREDGE &FILL a0,5 Lf'
QCAMA
GENERAL PERMIT
Previous permit #
E)New ❑Modification El Complete Reissue
❑Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
�J f r if t
f 1 r I o
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
/
�✓` l i
l
/
ElRules attac ed.
Applicant Name lr. ff 1 !-- C� f t''1 r^r�
fj�`'1''f
Project Location:
County �= ✓'� �`�y
.
Address 9!� 1s ; % 4� Ili UP 1, r'�
Street Address/
State Road/ Lot #(s)
City, £: ( State �'ii!f ZIP
Phone # ( ) / f E-Mail
Subdivision
Authorized Agent r ter` - ;rl� t'
City /% C`
,•- < , •f .. /r ZIP
t
e, �4' f r 6),
CW DEW OWA -[:MSElPTS
Affected
Phone # (
) River Basin
❑ OFA ElHHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body
J��'`. l,„ gnat,!/man /unkn)
❑ PWS:
ORW ( yes /, no PNA yes 'no
Closest Maj. Wtr. Body -
Type of Project/ Activity f ry' � E C7 � � e; .-. ��
� f �'/ '> �
c, t � ji i i .
l i✓
q to• 4. ; r: .- r Y"�c-% �7
t ,r.:
� )
(Scale: 4J.1
Pier
Fixe
Float
Fing
Groi
Z
- I Basii
Boat
Boat
Bea(
Oth,
Shor
SAV
Mor
Phoi
Wain
!NMI
I
MEMEMOM
Emil
Flength
V distance offshore
MEMIN
,channel
ramp
MEN
Bulldozing
EMIR
MMOMEM
I
IMMOMMMIN
MINNIE
a
0
dine Length
not sure no)
Des
1MEN
MEMMORNMEM No
A building permit maybe required by: (,- �' > c y ; 'r ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) i �• i
Notes/ Special Conditions ; r C 1 f, l; :.: , i > o F /
i
J/ �[ t � ¢ F 7,...F'.. � 3 .• T ,.,' 1J 6�'^" � - i 'Sr ' J i(�'..✓�. 1p ". �/ '1 jar 1,�+"� t Y� �`� / .
Agent or Applicant Printed Name, PermitOfficel Printed, Name -W-�-. �- ----- — -
t • t° i 1, �E �� ��' ,..�
Signature Please read compliance statement on back of permit* Signature
Application Fee(s) Check # Issuing Expiration Date

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 I) 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:
Tar - Pamlico River Basin Buffer Rules F-1 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/ 1-888-411COAST
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)
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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 0.?''2. 1
Name of Property Owner Applying for Permit:
-lailing Address:
let
1 certifN that 1 have authorized (agent) -a04 to act oil ni
belialf. for the purpose cif applying for jannti obtaining all CAMA Permits necessary' to
install or construct (activity) �O!/l�► "`�' �1 �b�4 1 jeA -e.,t
at (my propem located at) �bt t0, �rlJe
9�oPol4t(4 /Ste A)C--
This certification is valid thru (date)
Property Owner Signature
Elate
RECEIVED
MAR 16 2015
pGR1-M I-19 CITY

Q Complete items 1, 2, and 3. Also complete
item 4 H Restricted Delivery is desired.
als Print your name and address on the reverse
so that we can return the card to you.
IS Attach this card to the back of the mailpiwe,
or on the front if space permits.
1. Article Addressed to:
14c> A --
Po Sz)x 10337
C-VIW5'�/-'0r /qC1
A. Si afore'(
�( Ltl
C3 Agent
(j5+1r-j.
_
❑ Addressee
B. ,Rerved by (P 'fed Name)
C. Date of Delivery
\t i?3
D. Is delivery address different from item 1?
❑ Yes
ff YES. enter delivery address below:
0 No
�
a�
j a
3. Service Type
rertlfied Mall Q Expw MII
egistered 13 Return Receipt for Merchandise
❑ Insured Mall 0 C-OD.
2-7� - 4. Restricted Delivery? (Extra Fee) 0 Yes
2. Article Number .........
(Transfer from sWcefabeo 7013 1090 0000 3203 9934
I Ps Form 3811, February 2004 Domestic Return Receipt to25s5 o2•hf 15dr3
a Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
® Print your name and address on the reverse
so that we can return the card to you.
to Attach this card to the back of the mailpiece,
or on the front If space permits.
1. Article Addressed to:
9' Fl
tO 0- L
A.
X
N94ceived by (Prvrted Name) Rr�(
Dgte of Delivery
0V `�I1��`�-N(-tl 1 1—(�
D. Is delivery address different from item 1? 13 Yes
If YES, enter delivery address below: ❑ No
3. Service Type
red Mall 0 Express Mail
ITT Registered Ei. Return Receipt for Merchandise
❑ Insured Mal 0 C.Q.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
2. Article Number _
(rrarsferfrom service fabet) 7 013 1 D 9 0 0 0 0 0 3 2 03 9941
i PS Form 3811, February 2004 Domestic Return Receipt 1=95-OUi-1s4o :
RECEIVED
MAR 16 1015
DCM-N4HD CITY

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