Erico, Mike

GE & FILL
JCA515
5 0 1,
GENERALN PERMIT
B D
Previous permit #
❑Modification ElComplete Reissue EJ 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
Applicant Name I I Project Location:
GjRules attach d
County—,
Address Street Address/ State Road/ Lot #(s) I
City i7r`�T State !Q ZIP
Su
Phone # bdivision
Authorized Agent "—o City
ZIP
C3 CW EW PTA ES Eb PTS Phone #
River,Basin
Affected
E3 OEA 0 HHF ❑ lH 0 U BA 10 N/A
-x-
AEC(s): 0 Pws:
ORW: yes ,1/--no PNA yes no
Adj.yytr.Body --21�� -,Wat L an Lunr,!U
Closest Maj. Wtr. Body
Type of Project/ Activity
t
Pier
Fixes
Flow
Fingi
Groi
Bulk
Basir
Pbat
Boat
Beac
0th(
Shor
SAV
(Scale:/
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NEE0�.3�
IC
IN
MEMOS
MUMEMMEMEMMEMEMEM
MH
10
cubic yards
rarnp-�
ii
s
1ouW Boatfift
MEN
ME
MENOM
0
OMNI
IN
MM111
NEOMM
NO
M
Nils
Bulldozing
MOMMEMMEEMEMPI
MOE
a
MEMOMMEMMEME
UM LengtIl—f
EMEMMINEEM
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Now's
I
11mass
notsure yes no,11MEEMOMMENMEMMEMEMEMAMME11
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Mofttorium, Phot 1� MINE 0110110 MINIMErMEMO�MMrMMMMMMOM
n 0 Elm 0 Mom EWEN MMMMMMIMMM'—
s- IN
yes
d
A building permit maybe required by: El See note on back regarding River Basin rules.
( Note Local Manning Jurisdiction) t
Notes/ Special Conditions
A
r.
Agent or Applicant Printed Narpe
4 1.PermitOfficer's
Prinfed Narne/)
/Z I
i,
.
Sign#Tre,' Please!read compliance statement on back of permit"
17!
Si nature
Application Fee(s)
Check#
Issuing Date
i 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 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 that this 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 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
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888ARCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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.nccoastalmanagement.netl
Revised 08/27/ 14

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applyingfor Permit:
Mailing address:
Telephone Number:
(agent/contractor),
I certify that I have authorized
to act on my behalf, for the purpose of appiymg and obtaining ;11'--C--AMA permits
necessary for the proposed development of CP
AZV
This certification is valid through ' �, •— �`�� (date).
(Property Owner Information)
Pig —nature
N►{cq4t-L V. Mepi cb
Print or Type Name
Title, co. owner or trustee for property
Is -
Date
Telephone Number
Email AddressV
REcENED
furl 191015
i

t
19
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to %%1jC'�A� l 1% Fr rl L' s
9 ' (N a of Pr pertOwner) l
property located at g `A)/ G r C
/�
(Address, Lot, ock, Road, etc.)
on OdAz 5 cre,,e in— � dry , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
V/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development mus fill 4oscripVonAbel ,SCattatch a site drawing)
t.-
�,pvo CB
3 �
M
(Property Owner Information)
Ai
Print or Type Name
City t tlic ZI /)p
Date
*Valid for one calendar year after signature"
' t5 rut` e () . RECEIVED
Print or TypeamQ ` / A 2015
6:S5 o '/-�{ � .� f �J JUN 1
Maili ddrvss W141 i-Miu PA*
City/State/Zip
"C oZ �/ Z-
Telephone Number/email address
I /'�) - G-7 3 - P171
Date* ( (I z , j 1
(RevisedAug. 2014)

33632224-.Ai Duke Energy
03:33:24 p.m. 06-16-2015
r•,
1/1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to AL L �'I�l CG 'a
property located at �'�'
t11 C E � �Ru��InVf Property Owner)
.e
(Address, Lot, Block, Road, etc.)
on f°1'l> Ct�E c in 9C- AUf-6RT' 2S5 Ala , N.C.
(Waterbody) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
1Q On. �� Gr
1 � ✓1 have no objection to this proposal. r�i TI-A
I have objections to this proposal
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Tndivfdual proposln developmen m fillIn des ' tion bel Ora
a a site dra�ing)
� X g' •flit P' =!X 4'
ox�
n �, x� l x >l
y. 1W kIVSR SECT N
I LPbeset
that a pier, dock, mooring flings boat r mp, breakwater. boathouse, lift, or gr
back a minimum distance 15' m my lea of riparian access unless waived
ish to waive the setback, y mus initial a appropriate blank below.)
YdQ wish to waive the IV s tback quire enL
(Property Owner Information)
Print
Type
marrtngAoeress
174 �r1c�ENA W i4 Cfty/State2ip,
Clty/statemp
Telephone Nurnberl emaff address Telephone�u bor en
. ;- -7mia 1 F3
Date Date
Valid for one calendar year after signature'
03
jug 191015
(RevisedAttg.2Of4). to, u