Fulcher, Jr., Julian

C^IVIA /,.L^� 6REDGE & FILL k,/ Ga 7 0 N A B D
GENERAL PERMIT Previous permit #"
�JNew OModification ElComplete Reissue ElPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
J
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC i ie'
EJ Rules attac d.
Applicant Name
Project Location: County
Address Street Address/ State Road/ Lot #(s) I') J
City V State i ZIP::-
Eil
Phone #•-Ma
Authorized Agent
Affected
0CW AEW -,6PTA ..GES ,qprs
AEC(s): 0 OEA 0 HHF 0 1H 0 USA 0 N/A
0 Pws:
ORW: yes no IPNA yes / no,
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore-
-max distance oF.hore
4
Base n9l }U
Ct
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other —
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes m
Photos: yes no
Waiver Attached: s n,)
Subdivision
City ZIP
Phone River Basin
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A building permit may be required by: See note on back regarding River Basin rules.
Note Local Planning jurisdiction) 7
Notes/ Special Conditions AJ 1) u Y(1-
/7
ovO(­o OohW I)I,
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Agent orApplicapt Printed Name Permit Officers Printed Name
Signature ""Please read compliance statement on back of permit" Signature{
(7
Application Fee(s) Check # Issuing Date '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, 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 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
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. nccoastalmanagement. net/
Revised 08/27/ 14

>I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to v+ tczN �`'� i C
�_�property. lo_�a±e_ Wit. 7 g f.. ...._�_ _....� . _.�
(Name of Property caner
(Address, Lot, Block, Road, etc)'`�
on /1�a Yin , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to this proposal.
have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development gust fill in description below or attach a site drawing)
Oct,
P re p-e Y z* y /
/U D
TO Fulctih
Yoh %' v e ►�
Prop of+y
/ Nja R -i' ei �1iav�av �Q Ta ter7�
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
{ .Lc,f'
*nature
Print o 7 pNr�ame v
15
Mail' Address
-,— r-f A C. as.5'!1
City/StatelZip
25'2--7;Zr-
Telephone7lgi
/Number _
r i D r' / 1
Date
(Adjacent Property Owner Information)
' t - l EP 0 910T3
`Telephone Mumber b�l►�-�
C_ Ifs �S
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that. I own property adjacent to uu l a �V tr"j • �u C /� e
N arne of Property caner
(Address, Lot, B�I jc,,k, Road,`'etc.)
on d rah ia&r ,.in b�eld Flor'f ' (`a.r+4r-e- C.
(Waterbody) (City/Town and/or County)
The applic t'has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
N t.
erid o 04* oa l3crs
� ProP�rfY
/V o yi4 c J r
j` f�f Fulche
�i8a P ra yc r f
Prop .0- r fi
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
a_.U� . /-av,.
1gnature
Print or Type Name
-70
Mailing Address
ecj _ q t.'-o Y t lUe'.2Er5-1k
CitylStatelZip
-7�?_ r-7 1
Telhone Number
r, . .
(Adjacent Property Owner Information)
Sr ature /
(�wA/off - A,ao�k
Print or Type Name
y„r Z c4
Mailing Address
/_3 RECEIVED
CitylState)Zip
fw� �, i� ql G,•�., �C SEP 0 910b
Telephone Number
pm
Date
(Revised 61I M012)