Brewer, Chris

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GENERAL PERMIT Previous permit #
TONew ElModification ElComplete Reissue ElPartial 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
Rules attached.
Applicant Name Project Location: County W
P ty.
v Addressr Street Address/ State Road/ Lot #(s)
City
State ZIP
i --�1 101 -
, 7�r T"I Phonefl. 1, , Fax # L
Authorized Agent
Affected
0 CW EJEW El PTA ©ES 0 PTS
%
AEC(s): E3 OEA 0 HHF OIH 0 UBA ~ El N/A
0 PWS: OFQ
ORW: yes no PNA yes /,,.ho,l Crit.Hab. yes 'no,'l
Subdivision
City ZIP
Phone# River Basin.
Adj. Wtr. Body (nat Iman lunkn)
Closest Maj. Wtr. Body 0 CI
Agent or Applicant Printed Nam PermitOfficer's Signature
SignLure�,' "Please read compliance statement on back of permit" Issuing Date Expiration Date
Application Fee(s) Check # Local Planning jurisdiction Rover File Name

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, certifythatthis 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 Quality. Contact the Division of Water Quality 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
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Morehead City Headquarters,
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(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: [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 -below New River Inlet- and
Pender Counties)
Revised 08/09/06

I
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date (Jt j b ( q
Name of Property Owner Applying for Permit:
���. S i a � Lt.¢r � �£ w�✓
Mailing Address:
Ivc
/06 v- 9.%ks ,
I certify that 1 liave authorized (ageiit) •M 6(lNe5 oc 1 &% act on mv
behalf, for the purpose of applying for and obtaining all CA ik Permits necessary to
i'
install or construct (activity) �q Ple It
1 M pip ytA+e,4- ,
at m property located at Y'Q ad/+- Pivie knd +Ia( y P P tY ) ���ore � . �r` S
/ � f RECEIVED
This ccrtificatiots is valid thru (date) Lee, 3(, G 1y
OCT 15 7014
DCM-MHD CITY
c
Property Owner Signature Date
RECEIVED
OCT 1 5 7P14
DCM MHD CITY

. t
ADJACENT RIPARIAN 'PROPERTYOWNER STATEMENT
t here
by certify that I cv:^ property adjacent toy ' 1._
(Na a of pjpperty Owner)
ro erty located at # F'—
(Address, Lot, Block, R,oad,' 6te.)
•-, in °�.�.=..,�,; � ..�- �,.3-�--.._ , N.C.
(Waterbody} (City/Town.andlor County)
The applicant`has described. to me, as shown below:e td the, proposed at the above
locatio'��
/ tI have no objecticin to this proposal. „
t I have objectioris.tci this proposal
DESCRIPTION' AND/OR DRAWING'OF PROPOSED DEVELOPMENT
(individual proposing evefQprnent must in description below or attach a site drawing)
� � �� Wit..': `�°"•' y ,
� .. • i
} i
�'i"*lL.;. � .r._w^�`5...�F� { "'r ��• tji."\ .V.,.�.,:`1rhi �...C".� } �.,:. { �.. .^-.,
- M1 y $j y7
S.
WAIVER SECTION
I understand. that a pier, dock, mooring.pilings; breakwater, boathouse, lift, or:groimmust be. set
back a minimum distance of 15' frorri my.area of riparlart.access unless waived by me. (If you
f wish tow We file setback; you must initial the appropriate blank below:} RECEIVED
I do wish to waive.the .15' setback requirement. OCT 1 5 70t4
I do not wish to waive the.16 setback requirement. DCM_MHD CITY
(Property Owner Information) (cent Property Owner Information)
Signature
Print or Type Name
Plailing Address
Citylstatelzip
Telephone Number
7,
/Rovised 611812012)
RECEIv
ED
OCT 15 74'.4
DCM-M1.0 0TY

M
t-r
ADJACENTRtPARtAN PROPERTY OWMEH_gT�TEtfEKT
QwnM"
Ll
(Addnt:a, LOt Btrk #M
etcj 1^
,i'. _ IVYatetLlcayt ICst�towrt artdrlM Gou^tYl
Tre juLt auyd hA,s de-vil&J to rna. x.-!;vw!t LtW , 1s! ce,,vh;prcr, Pnrvoed A: tr =eve
•.!^, .. )�<s1`; 3 !.?JL` Ito SOy av, « ;h1E W:'tF v*
ss Uis yrr; p,;;Aaj .
DESCRLPTION ANWOR DRAWWO OF PROPOSED DEVELOPMENT
(ktdtvdduat ptspoatfg ¢ovakpenent rrwat Fitt in dtnatptkxt batow or &Mmft a sift drawing)
L }-L I 1 I
y � j
!1
WAIVER SECTION t � ' �h''
I tat:ary;,:ap lim a :Jet, :v:a. mfrErg sal:^+tx.:Ys6kwscu. ^efas8to�a,7, .%, tx gmin ma, W w
nz.k z m.rirvt ! ::srnva rt 15 trtR+ r..y crra of rpariy-f •,,ass u+l::ss wuivtd Py r;x:. 1 a g.�
WKh M wane fM_ 3et(L) M prat must int'Jel 7* Sor'W. le bLwrk L.W;W. )
�y.
(Property Owner inLornumon{
a.( If 7src Area
Rtr IrV A -,:Ws
raure.Y!.w..c..
(Ad' opaL`rOwner
JE�rv''•�-�non) z.
n. "�'
F ,7-�_. !-JS
ierlLt.ar.. i, X:C
3
RECEIVED
OCT 16 2P14
DCM-MHD CITY