Gillikin, Gary

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■ See note on back regarding River Basin rules.
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4

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 I) 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 howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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.nccoastaimanagement.net/
Revised 08/27/ 14

xc;k DREDG
E EDGE & FILL,
C . D
ENE AL PERMIT Previous permit # A B
New ElModification ElComplete Reissue E]Partial Reissue Date )us permit issued
previc
.....�A�,atith6a�,46dbishe StkeofNi h Carolina"�Departmeat-of Environment and Natural Reso ort urces -
and the Coastal Resrui�.es Commission oast in an, area ofvnviroental concern pursuant to 15A NCAC
Prulps attached.
A "icani R ��==
I Project Location: County_ a/k.
3 Address Street Address/ State Road/ Lot #(s)
ate.
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1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that-1 own property adjacent to G a r 1 .` l _ i h 's
{N me of Properly Owner)
property located at t)� �rc•v +�- tr r
�, (Addres, Lot, Block, Ra d
, a c
on Cra.&3 Cr&.e.t1 , in C'W r , N.C.
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location,,,.-) have
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)
5 e e. AlpaC-hMek17-5
RECEIVE®
FEB 2 4 2017
DCM- MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback
(Property Owner information)
Samna ure 4 �/ /��
r �,
Print 6r Type Name
/ti 71, 1. " C I
Mg Address
.,�
MGvDl.7Y
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Te1e 7/ 77 ail address
Date
*Valid for one calendar year after signature*
tyre
Tint r
ai n Add
City/Statea
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Telephone 1
Information)
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(Revised Aug. 2014)

Not for Recording
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The certriues that this copy of this Plat accurately depk;ta the
_ u ` of the jurisdiction of Section 404 of the Clean Water Act as
rf determined by the undersigned on this date. Unless there is s change In
t�� `+ •.., . 't, s the taw or our published regulation, this detemdnation of Sadiun 404 troundary J
�K
fit' YA .tyrK1 K N�1 Ewa
i .» wu jurisdiction may be relied upon for a period not to exceed five years
from this date. This determination was made ubkdng the appmpriste ?
tteglotraE Supplement to the 1857 Corps of Engineers, Wetlands '
R0r # t $y# `"""s" Delineation Manual. i
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® r17 SURVEY FOR
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- 101 George Taylor Road - Newport, NC 28570
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Ret. Deed Bonk 2e3 Page 231 do Map Book 1 Page 238
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FEB 2 4 2017
DCNI- NIHD CITY

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: G- Q r Y r 6�/ /// X-/ 4
Address of Property:
(Lot or Street #, Street or oad, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A"'cieschp n or drawing, with dimensions', must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what 1s being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is
available athtt :llwww.nccoastalmana ementnetlweblcmistaff-listin orbycallingl-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail._____
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 16 from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement
I do not wish to waive the 16 setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
Signaturff Signature RECEIVED
ur,iry et /411/ir/4 — B 24 2017
Print o►`Type Name Print or Type Name
_Mailing Address Marling Address
Ale w e 0 -1--, V C. :z s"
colstat Zip CitylStateap
z52-726— 067O
Telephone Number/Email Address Telephone Numberl Entail Address
./ Z2e�
e
(Revised Aug. 2014)

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This ce ifies that this copy of this plat accurately depicts the
boundary of the Jurisdiction of Section 404 of the Glean Water Act as
n. i determined by the undersigned on dos date. Unless tt ve is a change in
ft Ew N r fh4 lawn or our puWlshed regulation, Whit determination of Section 404W. �
jurisdiction may be felled upon for a period no to exceed Cnre years
L t ":•s: # — 'W r from 116 data, This determination was trade uftng the appropriate
1• • ;K t--" Regional Supplement to the 1981 Corps of Engineers Wetlands
Alt +wa+� Darteaban Manuel `
(Name) C r, g
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t'iii t ..r '! (Me(Date) d
(AIDS€) 201 C7c7:�d
SURVEY FOR
,..M m Gary Gillikdn
n wrra«.i. a (M lot ew GeorgeY P'o Taylor Road -- Nrt, NC 25570
M
rw r s» Rat. Deed Hook 293 Page 231 tic Map Soon t Page 236
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MORE NFORMATION PC-3612 �
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RECEIVE®
FEB 2 4 2017
DCM- MH® CITY