Gaskins, Richard Allen

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❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Previous permit #
[]New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Reso rce Commission in
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an' ea of envl!ronmeptal concern ursuant to I SA NCAC
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Rulesattac ed.
pplicant Name
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Project Location: County
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A building permit may be required by: 1 { 'irt ry (� : f r�� i `%' ) 0 See note on back regarding River Basin rules.
Notest/Special Conditions Yl , t = �j lt��i �, j f f :. , i ,1 .�`, } ,� /r y,��;'"`'�'{ �' �1`( mot• �tr
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Agent or Applicant Printed Name Permit Officer's Signature '
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Signature } Please read compliance statement on back of permit" Issuing Date 4 Expiration Date
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h Lgcal Planning JurisdicEion -" Rover File Name
Application Fee(s) Check #

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
❑ Neuse River Basin Buffer Rules
Other:
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/ 1-888-41kCOAST
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 (a >'r'
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that.I own property adjacent to J11 C k4 a n lit s
(Na e o Property Owner)
- _-�1?LoAeltyao_4atec _fit 1- O0 h ° r l-Ni - a. mil- ,� _ _ :...._ _
(Address, Lot rt3lAcRoad; etc
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatioP.
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)
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WAIVER SECTION
I understan ier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distanc . ' from my area of riparian a aived. by mac kyDu
wish to waive the setback, you mus ' opnate blank below.)
APR 2 0 1015
I do wi aive the 15' setback require IGM-MHO CITY
I do not wish to waive the 15' setback requirement.
iation)
Pri t or Type Name
r4o.. N I/-Ikl4-1 A
Mailina Address
+N C: 243S1(2-
Telephone Number
-11.15
Date
(Adjacent
Owner
tion)
RECEIVED
- DJj - — APR 1 0 1015
Telephone Number
_ 3 DCtA- 1I-"D Clio
Date
%ir�r✓�7/-7�7D
(Revised 6/1 NO12)

I hereby certify that. I own property adjacent to
L``r- Y 1 1/ 1
pro
on CA w in _
(Waterbody)
>n�.t,►iu<S 0s
(Name of Property Owner)
(City/Town and/or County)
I
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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
�real5e. �
unel•er' . 2
L,,F} y6
1"25,
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Equ s4 i tits Doc{,
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io
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.)
RECEIVED
I do wish to waive the 15' setback requirement.
APR 2 0 101;
- I do not wish to waive the 15' setback requirement.
(Probtrty Owner Information)
P.rir t or Type Name
`t oo N lZ►w��►►. lA�
M 'ling Address
A
QWStatelZip
Telephone Number.
-tl•1�
Date
(Adjacent Property Owner Information)
..Signature
Print or Type Name �
Mail�p�r, Address
%UUlr
Date
RECEIVED
APR 101015
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(Revised 611812012) _