Gerhart, Ron

T�CAIVIA El DREDGE & FILL
GENERAL PERMIT Previous permit #
7INew ElModification DComplete 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 I
112Ruies aitached.
Applicant Name g 4(i11 r t r jt Project Location: County
Address ,.3 Street Address/ State Road/ Lot #(s) 'Z'
!City f State 'W ZIP, t
,Phone # Fax #
Authorized Agent. r,
Affected 0 Cw — PTA DES 0 PTS
AEC(s): El OEA El HHF —0114 0 UBA El N/A
0 PWS: DFC:
ORW: yes /(n�� Crit.Halb. PNA yes no no
Type of Project/ Activity rj I �'T[ I
cf- (7-4
— N t
ii-( T.
Pier(dock)length
Platform(s) V K , 9 74
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp,-'--'-- t f
Boathouse/ Boatlift
Beach Buildo ,zing
Other
I - . - - -
' ':- —
' I
Shoreline Length
SAV: not sure
yes
no
�'Sandbags: not sure
yes
no
Moratorium: rVa
yes
no
Photos:
yes
no
/1'
Waiver Attached:
Yes
� no
Subdivision
City ZIP 7-
Phone# River Basin
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Adj. Wtr.Body [
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Closest Maj. Wtr. Body T- dcv 1c)
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A building permit may be required;
equired by: I
I —
Notes/ Special Conditions PJ tH-
on, F-1 See note on back regarding River Basin rules.
-------------
�gent ' or Applicant Printed Name
rermqvn7ers Signature
Signature "Please read compliance statement on back of permit**,- IssuingpateExpiration Date
Application Fee(s) Check# Local PlanningJurisdiction Rover File Name
.... . ......

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 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/ I-888-4RCOAST
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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date v i q
Name of Property Owner Applying for Permit:
1 \1)A1 lsedlAkt
Mailing Address:
1 Qak I�
P, �t kNo i Sly o Res
1 certify that 1 have authorized (agent) UO� -�AS ke,Ryl l to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) KAy A k
f
at (my property located at) 1-10 Oak I e Af
This certification is valid thru (date) ,5726
Property Owner Signature Date
. RECEIVED
JUN 30 2014
DCM MHD CITY

I hereby certify that I own property adjacent to R81 CTe.!S6A—r is
[� (Name of Property Owner)
property located at �►- Ic'00
(Address Lot Bock, Roto
et
�j)
on B04ile, � }LJ-IV r , in. � ►14, (fl '!�A6A-eS , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the aoove
lot�'
I have no objection to this proposal.
I 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)
sew A-�rx- C,hed�
1� RECEIVED
4
JUN 3 0 2014
DCM MUD 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 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) (Adjacent Property Owner Information)
Signature Signature
Ka �✓ 84f RJJ4.x La w
Print o Type Name Print or Tyne Name
1 �h. Shelaah 1Nxlia
M 'ling Address l/ Mailing Address
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City/Stat&Zip City/State0p
P Ks
Telephone Number Telephone Number
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Date Date
(Revised 6/1 &2012)

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0 Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
..9 Print your name and address on the reverse
so that we can return the card to you.
N1 Attach this card to the back of the maiipiece,
or on the front if space permits.
1.Article Addressed to:
�Or-
A. Signature
X9�� ent
LJ Addressee
B. 1ved (Printed Name) C. Date of Delivery
2.S')
D. Is delivery address differenttirom item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service
Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
lD� 14. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 1 7007 1490 0002 5322 2929
(Transfer from service label
I PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
.1366 Ns� eAU 1
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