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SCAMA /'DREDGE & FILL
O
GENE"L 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 o it
Applicant Name tip I .T -t e\ . r r F o ,t �, ..9n`�
ES Rules attached.
Project Location: County trteP
;Address �
I
StreetAddresss/ State RoadIc f #(s) i
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{City 'Ica11cliill tr, State�ZIP
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Phone # O Fax ##-.O
Subdivision
Authorized Agent
City ZIP
❑ CW/ P)EW )!PTA ❑ ES ❑ PTS
Phone # (-9�) Ztl 1-12`%1 River Basin rJ wle �.
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body n`�at man unkn
❑ PWS: ❑ FQ
ORW: no PNA yes / � Crit.Hab. yes / no
Closest Maj. Win Body
Type of Project/ Activity k
Pier Qqgge
Platf
Fing
Groff
Bulk
Basi
Boat
Boat
Beac
Oth
rShor
SAV:
(Sand
Mod.
Phot
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(Scale: .. )
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:NEnumber
length
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ead/(DIP- length
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■�`�■■■■■■■■■■■■■■■■■■■■■■
avg distance offshore 16
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
max distance offshore
■■■■
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■■■■����r1■■■■■■■■■■■■■■■■■■�■■■■r■■■■■■■■■
cubic yards
ramp
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Bulldozing
9p,
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MEN
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■■■Lags:
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notsure yes .
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er Attached: yes .
■■■■■■■■■■■■■■EENu■E■
A building permit may be required
Notes/ Special Conditions _
"rirr to l` �..-:❑ See not on back regarding River Basin rules.
j yy
1100 J I ( 1
7)� y
ent r Ap hcant f n ted Name
� f
Signature "Please`r ead compliance statement on back of permit
V
'Application Fee(s) Check #
-s 1
Issuing Date
1`-elliP� '4
Local Planning Jurisdiction
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, certify thatthis project is consistent with 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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-648 [)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:919-733-1495
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: 252-247-3330
(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: 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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLUTIBOATHOUSE)
• ; 7-11
I hereby certify that I own property adjacent to 'r ,e'! ;' r ` ,r ° < r t . 'r s.";
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on 1 1 1, 70T1 T`r r' , in !1" rel , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparianaccess unless waived by me.
4/ I do not wish to waive the setback requirement. i
I dD wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
('To be filled in by individual proposing development)
1
• A,
,Fitt"tea.'"
4 1
Signature — 11 `
R,� G V D. n�►'1
Print or Type Name
Sy() ] - 9 5 !Z0
Telephone Number 'j
Date: 1 ' } j� l ) 2 , z4 i [
_MAR-12-2012 12:05 THE�jELCO CORP 2167497462 'P.Ilr/001
ADJACENT RRARYAN PRO ERTY OWNER ST, AT Wr
(FOR A PIERIMOORING PIZJ41GSIDOATUFTI 1OAT#OUSE)
I hereby certify that I own property
property located at T
(Lot, Block,
(Waterbody)
He has described to me, as shown below,
and, I have no objections to his prof
pilingstboatIMboathouse must be set back a mini
of riparian access unless waived by me.
Ida not wish to waive the setba
I & wish to waive that setback
to
IL
ante of Property Owner)
mW and/or County)
C
development he is proposing at that location,
al. I understand [ that a pier/mooring
im distance of fifteen feet (151) from my area
i
requirement. t
E
uirernent.
------------— -----------------------f------------- ----------
----
DESCRI PrION AND/OR DRAWIN Or ; PROpOSED DEVELOPMENT:
(To be f:Ued in by individt al proposing devslopme�f)
'r
IP
L.C. F1 qq?-'r '
signature
Print or Type Namok
017
Telephone Number
r.
Date: , C 7J ,Z. 2- n
TOTAL P.001
i
E
.03/13/2012 12:53 9195838790 BEST COMM DEV i PAGE 01/01
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North Csrotins Department of EnvIronment and NaMml R - organ -
DIVISICM of COWUI Management i
sever? caw Wok Gomm Jam= H. G"on, arewr ov"ra�mea rxea�ry
r
Date
Applicant Name
Mailing Address
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I certify that I have InIborimd (age�o9 4t act ou taxy
bchali', for the pagmscofapp]Ybg for and *bWAWg all CA1MiA ]emits A, txcssary to
at oomdoa)
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phone: 1114pg1FAX: 262-W-W k InWret www.,,maskma
�nployer-� k+t1 �oX, Posct�er
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