Mangum, Jeff

QC]CAMA /*IJDREDGE & FILL _,...,,,
GENERAL PERMIT Previous permit #
T!fNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources lit
��and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC fi
• = C j - -..'� _ _ .-_ —� Rules attached.
Applicant Name ` -%.:.�r r�, t }'Y Project Location: County�f i 1' 1_Q'
Address ` r j�.'1 �% 5s� � , F� Sr Y 4 0 Vt ! r Street Address/ State Road/ Lot #(s)
City, �» �� t "l i �: t
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Phone # (`` t -- t�'i"�ax # (_) Subdivision}
11.'Cityuthorized Agent P
Affected ❑ CW to EW j PTA 5�ES ❑ PTS Phone # ( ~ fiver Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body , y �. i1!.1) ~ ` E ,\1 l `�I nat ma,1 unkn
❑ PWS ❑FC:
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ORW yes /ono PNA._k,yes /%no Crit:Hab._ yes / no-} -_ -- -
Type of Project/ ActivityA��0(AAU)`��I�i1��(�`+;
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A building permit may be required by:
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
I J 1r
/{gent orApplica+xPnruedN e *
Permit Officer's Signature
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Signature �7i r.rr
g Please read corftpliance statemer on{iac of permit
Issuin Date d
f Expiration Da e .
ApplicationFee(s) / r
Check#
LocalPlanningJunsdiction
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 andvoid.
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, certify that this project is consistent with 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 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/ 1-888-411COAST
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

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Aug 06 01 04:23p triangle landscape supppl 9195576802
Jun. 05.201,t 22:15 18282959869
Auo OeOl 02.51p triangle landscape supppl 9195576602
AWAONT RlpAIy PRO 0tN�R S7atEMEhls /� �
hereby certify that I own property adjacent to J e� '� *.�� 1' "t Fri
property l
o
cated at f Q (NarvIe of Property Winer)
on Ct�h� AAd rasa, Lot
1 lock, Roo atc,AJC-. `!
(Watarbody) (City/Town and/or County)
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PAGE. 1/ 1
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IM
The applicant has described to me, as shown below, the development proposed at the above
location. ,
I have no objeatten to this propose;.
1 have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(fidividua/lptaposing developnle"tmust roll in descrtptlon below oraftach a sf'te "Whig)
WAIVER SECTION
I understand that a pier, dock, mooring pilinga. breakwater, boathouse, lift, or groin must be set
back a minimum distance of 154 from my area of riparian access unless waived by me. (if you
wish to waive the salbaciC, you must initial the appropriate blank below.)
1 do wish to waive the 15"setback requirement
I do not wish to waive the 15'setbsck re4ulrement,
(Props Owner) n ormation) (Adjacent Property Owner Informallon) &
e �'� xbl� .
U Signature _
Print or Type Natho Print of Type Name
-3-600 1?ltQ.e-Pr,rl''� a
M#rrv►gnddreBs ,N'G 2-752-4 Meit�n� �dr
(�(y t Fe2fp
I a-7 q! S 5 5
TeiaPho,R� Number Telephone umber
Auld Dale
(Revised OM 6/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(Bulkheads and Riprap)
I hereby certify that I own property adjacent to
(Name of Property Owner or Applicant)
Phone number you can be reached at '11
Mailing address if different from location: 3600 100ac,14C.-I ✓`iaegG /a,
Property located at
(Lot, Block, Road, eta)
on Bot u et ��wya4 . , in /7'T,4/ Hc, A&A. N.C.
aterbody) (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be, filled in by individual proposing development)
C.e, s, .+ J 0.4 le- h ea.P
wo.ik 1 pe-0,
01 4 v, Goto bO t
Print or Type Name
Telephone Number
Date: t1
uccoastalu=agementnedPermits/ADJACENTRWARL4MROPERTYOWNMTATF14FI' l.pdf
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