Maddox, Gene

T-
�OjIVI AA/ El DREDGE & FILL
;GEINERAL PERMIT Previous permit #
New ElModification ElComplete Reissue'• ElPartiall 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 arel of,envir nmental concern pursuant to I SA NCAC 00
'5111utes attached./
Applicant Name 0 , i- I - I Project Location: County ri{,) �� �,(% . IAddress Street Address/ State Road/ Lot #(s)
XY StateAL ZIP
,Phone [F
1Subdivision
# '"Fax #
,Authorized Agent City ZIP
Affected D CW XEW �TA DES El PTS
AEC(s): 0 OEA 0 HHF D lH El UBA El N/A
El PWS: 0 FQ
01RW: yes/ no PNA yes Crit.Hab. yes / no
Phone# (-, . - —) / River k�"-1 rtj;
11
Adj. Wtr. Bod i Y f,(nat fan /unkn)
Closest Ma. Wtr. Body -
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Agent or Applicant Printed- Name
Permit0f
Signature "Please read compliance statement on back of
7
Issuing Da
GC/ Vriq*t,
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Application Fee(s) Check#'
Local Plan

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 [)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, certify that this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules F� 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/ 1-888-411COAST
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

CIS ��3'J3"A'O'n "v _{ z` zq:.Ifl la o'
�
Applicant: fy)
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
/
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ .'Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
232-808-23M, .. .. vevil-.304. 0=31-30

03/04/2013 03:45 12524307070 BDC PAGE 01
03iO4;2013 MIT FAX [phone] B&B OFFICE PRODUCTS 20Q2
�3x
ADJACENT RWAR AN PROPERTY O
WNM (FORA P1Zjt1mQOR/NC PILIN/BGSOATLI �oU� SE ��
I hereby cerdfy that I own ro
P Petty adjaernt to Gt►tC �erg ,
(Rune of Property Owner}
PtOPM. )Dated at /o eg C-Jv-4 . .
(Lot, Block, Road, etc.)
on dY) _..., , in _ _ e� .__, N.C.
(Town and/or County)
Re has descnbed to me, as shown below, the davelopmcnt he
is proposing at that loCaiton,
I
and, have no objections to ris proposal. I understand that a pier/rroori.��
pihn¢srboarlifi<'bearaousc must be set back a z►inirnum disranc.e of tiftccn fit. (15,) fran; m a
of ri nRn access uWess waved by me. y a.e..
I l�2.L1Qt wish to waive the Setback requirement. R1yCEIII
wisLi
" to wa;Ye that setback requirement.
MAR 12 2013
DESCR Mot; AND/OR DRAWLtiG OF PROPOSED I)Eti'-L'dl'A'�C
(To Ire filled in by h vUual proposfng dTvglopmen,
Signature ,Q
Print or Tye; Namc jej, ,c igdhl���
Z'`!)- 1�{�S'- '�%J
Telephone Ni mber �—
Date:

• ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ,s
(Name of Property Owner)
Property located at �d (f 4.." f3 G .
(Lot, Block, Road, etc.)
on N o L in e> &" -e'weer , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand . that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from y area
of riparian access unless waived by me. SCE►
I do not wish to waive the setback requirement.
_ I dQ wish to waive that setback requirement. ��.glDCIV
DESCRIPTION AND/OR DRAWPiG OF PROPOSED DEVELOPIMENT:�w W
(To be filled in by individual proposing development)
00 .go alp
y—
Cr0' �L4
Signature
1A14A1 b S. hVU�I km N
Print or Type Name
3 93 — 6 0 46
Telephone Number
Date: p 3 0