Glancy, Milena Mckee

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ElCAMA/ ELDREDGE & FILL i •--;3`
GENERAL PERMIT Previous permit#
ONew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issue_ d
As authorized by the State of North Carolina, Department of Environment and Natural Resources,` f/
and the Coastal Resources Commission in an area of environments( concern pursuant to I SA NCAC
Rules attached,'
i4pplicant Name ? I i ` "F project Location: County
yy j
;`/Street Address/ State Road/ Lot #(s)
;Address-
I'city '' State zip
Phone # ( �� )_ ^,i 7 x.Eax # (�,) Subdivision
uthorized Agent+ �; ' '�-r ,+ City + ZIP �� f
Affected ❑ Cw ElEW ❑ PTA �tS El Phone # ( ) I - ') -� >" River Basin
AEC(s): EloEA ElHHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (� 1 _ t "J ) J l 1 : ( at /man /unkn)
❑ PWS: ❑FQ l ��
ORW: yes /ino,/ PNA yes f no J Crit.Hab.....yes-/-no-- Closest Maj. Wtr. Body 1
PIP
; gent or Applicant Printed Name I PermitOfAcer's Signature _ y
Sig/nature Please read compliance statement on back of perr�r t�' Iss ing []ate ! „Expiratiorybate r i
ApplicationFee(s) Check# Local PlanningJunsdiction ' Rov&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, certifythat this 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 howto complywith 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 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

AoA
` + NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date /I 16 ` A%
Applicant Name
Mailing Address
0. (-J q'A C
John E. Skvarla, III
Secretary
RECEIVED
NOV 17 1014
DCM-MHD CITY
I certify that I have authorized (agent) A�u, 6ewc, /1�.�; Ne to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
:T 4S ' f( 4-OC ,+<ea TS` 1 .4,0.0 o , at (location)
dlt r-bvQric
This certification is valid thru (date) /2 - 3 / le-1
Signature
RECEIVED
NOV 2 4 2014
atm-l"drr
400 Commerce Ave,, Morehead City, NC 28557 One
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net NOrthCarolina
An Equal Opportunity 1 Affirmative Action Employer Naturally.
i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to lena mr—kife
l anc}�
(Name of Property Owner)
property located at IrYA ILk P. ,
(Lot, Block, Road, etc.)
o in t,��P Co k k-�O r , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #a�-72 a 53alailing Address: =q k6r
ipa r4-. G
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
------------------------------------------------- 7-----------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
tm
(Information for Property Owner Applying
for Permit)
��� Bd
ailing Address
P, au 4 P�/ l)6- ol'cj51,6
City/State/Zip
RECEIVED
Arnv 171014
DCM-MHD CITY
(Riparian Property Owner Information), --
FEAV - � R - M �, W 2, 0 H �
Cl ::11'gnature
V6I i rO
Print dr TAM
elep one Number Telephone Number
/(c l _ f e
/ q
Sfg a ure Date Dat

ADJACENT°'RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to \ e..r Q hA c_ke'_ (710'racy
f (Naqie of Prope O ner)
property -located -at . .... _ _ ... _
BT;rnr'�CAr-%
'd4 (Address, L t, Block , Ro d, h
onto �k , in ,r-�'1' , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiop.
1/ 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)
C-ece It
A av
POW
:OA
y
RECEIVED
NnV r 71014
DCM-MND CITY
WAIVER SECT104 -." �
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.)
do wish to waive the 15' setback requirement. RECEIVED
I do not wish to waive the 15' setback requirement. NOV 2 4109
(PropertyOwnerInformation)
;Sffa re_ _ _
P-n G� I'i%` 1 n' l _
Print or Type Namebe
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