Goodwin, Hazel

V.
Y,DiWMA / El DREDGE & FILL
GENERAL PERMIT
Previous permit#
BNew El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources -7J J
Coastal Resources Commission
and the in an area of environmental concern pursuant to 15A NCAC
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'Applicant Name f { �' ���' o r t� r '1
❑ Rules atta hed.
Project Location: County ( C✓ Pd P
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Address �' C :f -- �..j c— J
Street Address/ State Road/ Lot #(s)
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State : W ZIP � (M1 t b
10 �E'� ! c/ r! L '`r �' G ✓
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Phone # (.� )�i�s # (_)
Subdivision
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Authorized Agent (. �° ,1 i t r1
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City f elf, .. � f G''� ' ` � ZIP
Affected ❑ Cw i TM -p PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Phone # ( ) _ `� River Basin
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AEC(s):
Adj. Wtr. Body /��✓-I ` e a" ma unkn
- ❑ PWS: ❑ FC:
ORW: yes no PNA /Jesl / no Crit.Hab. yes / no
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Closest Maj. WinBody G ^
M.-M.
VAN
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Agent or Applicant Printed Name
PermitOffiE r s ignature
"-�
Signature Please read compliance statement on back of permit
Issuing Date
Expiration Date
j
IApplicationFee(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, certifythat this project is consistentwith 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 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

' . ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
,-7 3C,o % _NHame gP operty Owner)
property located at D a'5 eQk s/ �7%(�.- a
A� (Address, Lot, Block, Road, etc )
on . Dr A , in � cda f- � , N.C.
(Water dy) ( ity/T n 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.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVE
(Individual proposing development must fill in description below or
3yd 1
ENT
ch a site drawing)
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or gro
back a minimum distance of 15' from my area of riparian access unless waived
wish -to waive the setback, you must initial the appropriate blank below.)
V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Ature5 OlY
Print or Type Narne
M fling Address
ed4n/s�,�
C y/S te)Zip
e 6k- xs A.'a4 ,
Telephone Number
Date
3--)y-1y
must be set
me. (if you
m)
gdNf- . .
cityistm (0,5- �
T /e h ne Nulnblr�158
Date rylo- r Va(� Q lLl
(Revised 611812012)

A® R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date Maw a S , ti-014
Applicant Name �f a le— I Gzvdw t h
Mailing Address 4a)OIC40 cedar7T5(wjd Rd
�` �Cclar ��r�d,�, n1'G ass52t�
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
1N'o(41, (3ay -Di+cA /Cedar
This certification is valid
Signature
(date
MG , at (location)
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
NofthCarolina
Naturally

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
PAM
I hereby certify that 1 own property adjacent to ��l�%
2'e
l
��
me�f
(I
Prop"
Owngr)
property located at W 4
3
�
�4 o�
r- (Address,et, Yock, Road, etc.)
on 69A-If4LJ N.C. A
(Waterbod) (City/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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site
� �IK
15-2(7
L%
(5y
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.)
do wish to waive the 15' setback requirement.
If
I do not wish to waive the 15' setback requirement.
Telephone Number
121)_ - 39�1 --2� Y�
Date Iq
Prin r Type N$me /
o� �� o
nn g Aa ress
Tel'
h�oqa Number
Date
(Revised 611812012)