Gaskill, Edna

;eCArOA / DREDGE & FILL
GENERAL PERMI(LZ)
?blew ❑Modification ❑Complete Reissue ❑Partial Reissue
Previous permit #
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 egvironmental concern pursuant to 15A NCAC
�j j Ci7Rules attached.
Applicant Name Y�Jt-.� l project Location: County
Address {r i Street Address/ State oad/ Lot/#(s)
ty
t t^ � '' StateA)(- ZIP ,j'S: l ( � cif � i
`� -
C
?Phone # ( ) '" lr' Fax # (_) Subdivision r
`Authorized Agent 12 City _I4 �r ZIP
Affected ❑ CW 0 EW O PTA ❑ ES ❑ PTS
AEC(S): ❑ OEA ❑ HHF ❑ IH ElUBA ❑ N/A
❑ PWS: ❑FC:
ORW: ye✓s� / no PNA yes / Cn Crit.Hab. yes / no
Phone # (_) River Basin✓' Crlfitr
Adj. Wtr. BodyG,/t c. l nat a unkn
Closest Maj. Wtr. Body �'"`�` ter/
Type of Project/ Activity %`ta I"k eA r'tr Vn J l .' rj
(Scale:
Pier J
Platf.
Fing
Groi
Boat
Boat
Beac
Oth
'Shor
SAV:
:Sand
Mo
'Phot
Wai
r pier(s)
r120
length
1
OAWMEMMM
number
max distance offshore
INS
cubic yards
ON
'A
MEMO
IMMUMMOMMEEM
rarng
Lgs:
WIN
MENEM
noi sure yes
s: yes
-:: `t,
A building permit may be required by: 611,—/ j �� ❑ See note on back regarding River Basin rules.
Notes/ Special,Conditionsl 4 I a 7 S �e f f"/g .-a n [✓+� �/ 't ! x^"'� (t �Gj�C f �i rr;_'�
l r
I !
c z t r s t' Ary c.
4y j r f.
Agent or Applicant Printed Name Permitbfficer's Signature I
q—
Signature * Please read compliance statement ackofpermit" IssuingDateExpiration Date
Application Fee(s) -r-Checki Local Planningjunsdiction Rover File Name
l

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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules F-1 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 howto 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 Elizabeth Ci�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 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

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date
Applicant Name lq K j [T'�"
Mailing Address I S 50 ffw 4 /0 l : Aa u dadc— 0 P C a �Y3z
John E. Skvarla,11i
Secretary
I certify that I have authorized (agent) &K H. 41ns aY to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
910
Ak-.t' N4--
This certification is valid thru (date) 5—
Signature
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer
at (location)
None Carolina
Naturally

I hereby certify that I own property adjacent to ,s
a Property located at 0/74 S`&cv ". Pe..1 (Nme Of h► Owner)
Vri%t r v ' (Addnbss, Lot. EM
Road, eW-)
on
in G.
ate ody) (C /Town and/or county)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(ln&vl w proposing ditWopment mast Nil In dssrxlptlon bWow or attach a slta drawing)
WANM SECTION
I understand that a pier, dodo, mooring pilings, breakwater, boathouse, IK or groin must be set
back a minimum distance of 15' from my area of riparian access Mess 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 f Inormation) (A Pro
party Owner Infonnation)
Sri
QC -a Hf � ay Si � / 14 C. y �/1�. �e.�Avc'i 5 �Ph 1�E'C:l�
Pr torTypoName 7 n....--T-- •.---
2)
CVA00
-�'4cYf /V G, Re5-c?/
NkwAbw�.� — TeJelahw* Nuffibw
Date
(revised 8hamn)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
` 1 hereby certify that I own property adjacent to
(Name of Property Owner)
I
property located at -4fd S i-c
(Addriss, Lot, B.Lock, Road, etc.)
on , in RG , N.C.
(Wa body) (CI/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I'have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description below or attach a site drawing)
/3r-jfi
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 IV setback requirement.
(Property Owner Information)
To/ hone Nu ber
3i k3-�34t�
Date q _� 7— t 3
(Ad acent Property Owner Information)
0�'�Lw'7
Signature
Ck+gLYL e, s
Print or Type Name
Po 15.0-f '3-6�i
M iling Address
- .-.vc 2X5/6
Citylwatoaip
Telephone, umber
Date
(Revised 61 &2012)

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