Leach, Bryan

2
C'�CAIVIA 0 DREDGE & FILL
D
GENERAL PERMIT
A B
Previous permit #
New ElModification E]Cornplete Reissue 0 Partial 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 environm ntal concern pursuant to 15A NCAC
MRules attached.
Applicant Name
Project Location: County J,
Address —1v
Street Address/ State Road/ Lot #(s)
City—," "I. State ZIP'
Phone # E M 'I
Subdivision
Authorized Agent
City ZIP
ty—
El CW 'I.4W NJ�PTA El ES El PTS
Phone # River Basin
Affected El OEA D HHF 01H 0 UBA 0 N/A
AEC(s):
:A-r
Adj. Wtr. Body I- A' (nat /man /unLn)
,E]. PWS:
.. p
Closest Maj. Wtr. Body
ORW: s'k no PNA yes i,(n,'o
Type of Project/ Activity
Bulkh
Basi
Boat
Boat
Beac
Oth
Shor
SAV
Mor
Phoi
Wai)
(Scale:
MEMEEMMEMMEEMEMEMEM
MIMMME
length
number
eadl Riprap length
M
INEEM
��
NOME
avg distance offshore
max distance offshore_
iii■■■i�i
�iii
,channel
cubic yards
ram
house/ Boadift
I
i J
MEN
MEN
h Bulldozing
MEN
w
MEMEN
HE
EMME
M2709
ENN
ElmMEREMEMENMENSIMMEMEMP
I
Im-1
ui
NEMENEEM
mMEMO
no
ON
w
HEMENEENOM
IM0
MEN
Mjg
EMEN
INE
MEN
notsure yes
ENH-9-0
---
Imm
MEMO
,torium: n/a yes no
FS: yes no
0
'1
MINE
mr&wc�red: VPS
Saffimm-11VANNE
A building permit may be required by:
(Note Local Planning Jurisdictionj r [J/,
otes/ Special Conditions k
f I
EJSee note on back regarding River Basin rules.
f
J'
31
Agent or Applitarit Printed Name
i
Permit Officer's PrintedName
\\--Q �le
Signatyre r e read compliance statement on back of permit"
Signature
Application Fee(s)7
Check #
Issuin' Date
9
Eipiration,

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
landowners).
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 consistent with 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth Citv 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.nccoastalmanagement.net/
Revised 08/27/14

Y��.

AGENT J WTHO RIZATION FORM FOR PERMIT APPLICATION
Name -of Propt trl , 0 weer AppI
Mailing address:
Telephone Nuriber:
7
j
certify that I h ive ai ithorizE:d ¢� a entice rtractor
to act on my be half; i:)r the purpose of 4:pplying and obtaining all CF► permi
A
. nary for tl �e hrc posf�d developmej it of � Cam' !� V r Q
Q[�21 Ra�1
at my property I ocate l a d L
This cettificatioii is valid through ^� � —(date).
(Property Own :r Informittic, n)
Si; Tnr,tuj a --
�i� �.C_k
Pnnt or 7 Vpor h 9me
Title, co: owner )r fru: tee ; or property {
�2.- 5, 20/S
Da fe
Telephon.: Number
S_r&q4ZA,, 0 10(Ab!C�5CGAO If L& C, CO/O
Email /.dQre:s
RECEIVED
DEC 0 9 2015
DCM_ MHD CITY
RECEIVED
DEC 10 2015
�-' i� u 4 C{ i✓ i � Y

&1AC-g-_h T -RIPARFAI I PROPERTY C'VYNER STATI;:MEN-E
• 1 hereby certil it tl st owr. pr )perty adjac .nt to
��� r ame Property C* wrn I
property-locai ed at. ram:;
( , dre Lot, Bla ak, Rc�ad,
on � etc..}
l'V _ C�_, in`_I N.C.
w!
(tYat erbody:. (Cityfrown and/or Coin y)
They !' h• is i lescribe I to4ne as shown below, f * development proposes at the above
locatio .
I ..iav E) no objection to thi: proposal.
im a ob eci ions to this I roposal.'
[ ►E: Gf :IPTIOIN ANDIOR D 2AWING OF PF OPOSED DE'IELOPME
(Individual I ,%jo1 ing clef elopment n iust fill in desci Iption bel w oKattach
i
INAIVER SECT131
understand tt-.a::l pier, d xk, moorirn; pilings, breakw ater, boathou:,e, lift,
back a mini ,nu r (listarice of 15' from my area of ripai ian access ur less v
wi$h to wain e; tile =►etback, you must 1i ritial the approp -late blank below.)
T
—by me. (If you
DEC 0 9 2015
I -Jo , vish to vialve the -15 setback requirernent. D C M - M H D CITY
I io riot %vish to waive th :15' setback requirement.
(Piro arty � 1w %er In o;'tma J094 (A! cent Property Ownet nfotmation)
12 el/
of or Type ! N: �n Pt :nt or T Nam07 e
Wiling A 1s. M i7i g Addr s
N Cn�lV , e
C 19 lei V — Cl y/Stat (p r Ln 7
Telephone j ru? / _
�P
,c7o c.l _ S OC � — C<&�o�,— _ 7� � ephone Numb ;r
r� ibe •
_-RECEIVEP,
Date
DEC 10 2015 ( evised 611812012)
DCM- MHD CITY

A[ JAC U TT �RI-1 PROPERTY C,:WNER STAn-wEN'f
• I hereby certil ,r ff at owr. pr )perty adjac 3, to
ame Property Own(
proplerty {oval ;;d at . L�:�` M
'0 . (.1
{ , dre Lot, Bic i:k, Rgad, eon in
tc,.
V(t!ilai erbedy; . (CltylTov+m and/or+you+
The; appli 11 h,,s describe I toa me, as shown below, t +e development propose+
locatio .
�N - i ►av a no obj ection to thi: proposal.
1 im a ob ed ions to this 1 roposal.
E ►E:'.CF JPTIOh ANDIOR D 2AWING OF PF OPOSED DIFIELOPME
(Individual I i%)os ing (lei elopment n rust rill in desa iptfon belo wDiattach
' NAIVER SECTI M'
understarK I that : t pier, dock, moorin1l pilings, breakw.ter, boathouse, lift, or g'
back a mini ,nu-n (listarrce of 15' from my area of ripaiian access urless waive
wish to wain e- tiie :ietback; you must Witial the approp date blank below.)
to 1+rish to waive the -15 setback requirernent.
1 io -jot %vish to waive th :15' setback requirement.
(Pto erty 1 (A
STpjahre
of or Typ+ ; N. Ime
-
Wiling A ►'� _ 2��� S
C' 1State2 RJ
Sac•
T61ephone j 1ur ibe
Date
;nature
N.C.
Y)
at the above
T
site drlWing)
NW
iin mu§t be set
by me. (If you
RECEIVED
DEC 0 9 2015
�; W D-CITY
nformatian)
RECEIVED
D-EC 10 2015
DW- Afi ,�j r-
( evised 611812012)

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