Evans. James R.

M-C,"AIVIA /,DREDGE &FILL
4
GENERAL PERMIT
Previous permit #
NNew 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 A(
Applicant NameLL
-�Rules attached.
Project Location: County_
Address '4\
Street Address/ State Lot #(s)
City State ZIP)
/Ji
_
'Phone # I #
Subdivision,, ti r
t
�uthorizecl Agent
Ci i "� �
ZIP
XCW VEW glPTA [DES Ej PTS
Phone# River Basin
Affected
0 OEA 0 HHF 01H 0 UBA El N/A
AEC(s):
Adj. Wtr. Body (nat ftman `%unkn)
0 PWS: El FC:
OIRW: 46 PNA (nio') Crit.Halb.
Closest Maj. Wtr. Body I Y
no
yes yes
yes
Type of Project/ Activity Oinlv`),
77
i :N
(Scale:
Piar f
@�
��ii
i length:■@■::■:■::@@@::::::Q®®:■::::::emu::
-number
MEN
avg distance offshore
lgffu-6�9OMMIMMIJ
r�::0N
�:al
wal"WENINE11111MON
max dstance offshore
MENEENNNE
.�..�..,.....�.�■■.■.■:
,channel
ENEENNEEN
■■■�
■®■■■■■■■■■■■■■■■■ee■■
■■■■■■■■■■■�i
cubic yards
ramp
iouse/ Boatlift.
INEEN
N
.i Bulldozing
r
dine Length
not sure,,, yes,
Fags. not sure yes
torium: �n/a yes,
y es ifn■■■■■"■■ii:::iiii■�ii�ai::::a::::
-rAttached: t—yes, no
■■■
■■
■@:��i:i::::::■i:■:�:::::::
) J I F "
A building permit may be required by: II/D
-N
Notes/ Special Conditions 9 0
Seenoteon back regarding River Basin rules.
T
kj
A
or Applicant Printed N e
dPermit Officer's Signature J
'Agent
'Signature **Please read compliance statement on back of permit"
77
Issuingl3ite.,
EkpiratioDate
h
App'ljcation]Fee(s) Check#
''LocalPlanningJ riscliction—,.'Rover File Name

pri
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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules 0 Other:
0 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 complywith 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

ii"� � 'C)3��7;.�� 6� .�� ?' ? `� ? r. Vic.. e jx �e.�a•t `!'"` �. �,',`� �35:i,�,�a� ��, iyi(i.;`?•
Applicant:
Date: a O
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance -total
'Includes any
anticipated
restoration or
temD impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any .
restoration and/or
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
1\09n
redge ❑ Fill❑ Both ❑ Other
9
�4)4/4
Dredge ❑ Fill�k Both ❑ Other ❑
(52
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ .Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ - Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑
Dredge ❑ Fill ❑, Both ❑ Other ❑
Dredge ❑ . Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
��'�-w��-���'� :. 11 ����5L��6>3��� a .: �n �.a 9��ea�:�s�8o�a�����,�n�5at.�•e`3

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 1 1 - ► -1 • 13
Name of Property Owner Applying for Permit:
^
Mailing Address:
'3 oo Z Ac
x
` NOV 14 2013
r,•.
MCM MAD CTTY
I certify that I have authorized (agent) o < �<� �t� M� Ili <to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) SE PL,-/� DO
at (my property located at) Z ©c.D Ca,-.Trw 2 a D �!
This certification is valid thru (date)
Pr4e�y Owner Signature

ADJACENTI RIPARIAN PROPERTY OWNER STATEMENT
I hereby -.certify that l own property adjacent to K 's
(Name of Property Owner)
property located at 2I o 0 LO G,A✓Sl.....o.� TL.
(Address, Lot, Block, Road, etc.)
on m oa w L h� T�9 .-r , in a �- -o -- . •r- 1�,ev c./I-N , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
rn��rll o'tr031-iti1 P;)ITS
i�1etS INS
LI
I�c c—+wc—
o
F NOV 14 M3
DCM-MHD CITY
:�
'5Z= Sa, WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
i)1- 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si ature
:E-V"-- -S 9- C.r a-':s
Print or Type Name 3'a TD tn� �UJw fronn
Mailing Address
City/State&ip
"1 1 1i (P 1 11 Yce t b
Telephone Number
`L-z-C- i-,�
Date
(Adjacen etltij Ow er Information)
, -
Signature
-�E
Print or Type Ndrne /� '
�� (n f)1 S 0 �a 1L P r I %J S
Mailing Address
QN!
�tatelZl�I-�5`c�
Telephone Number
11- 13. V;
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �14 m C's c 's
(Name of Property Owner)
property located at
Z1c7 0L_0Ge,
D 14
(Address, Lot, Block, Road, etc.)
on (» oo ►., l($ L,i 139 !:r , in. A+L a.,... ,*C q c h , N.C.
-�(Waterbody) (City/Town and/or County)
The appl!,caKt has described to me, as shown below, the development proposed at the above
locatio .
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development mus f I in description below or attach a site drawing)
o • � K-
A�v 1= t�5�� p�c
�YiS.i-n�5 R+Cj�
Co'4Cu-C-T N`r -J
It1~CE M
NOV 14 2U13
l CON S �A u- �� DC'M MO CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish towaivethe setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
I?
Print or Type Name
)7%,,e-14 N. C.
Mailing Address
19 1, t 1p � 6ct Co
Ci46§tate/Zip
C. Z( ? - tom
Telephone Number
Date
(Adjac
ent Property Owner Information)
ature --�-
Print or Type Name
Mail " Add ss
City/State/Zip/
Qi /41 -- 2-/S` �S- 00
Telephone Number
Date
(Revised 611812012)