Mitchum, Jr., William

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A B r C D
GENERAL PERMIT
Previous permit# -
�DNew ❑Modification ❑Complete Reissue El 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 environmental concern pursuant to I SA NCAC
+
Is Rules attached.
. Applicant Name i : + i '4 r + j'' `, ' `' f': f lr'i ''1 . Project Location: County
Address Street Address/ State Road/ Lot #(s)
City i : , (- State,_ ZIP
Phone # (} E-Mail Subdivision
r-
_
Authorized Agent i , f a ,r `'xR` �t ' i f City
1 ( t'"� ZIP
ElCW _p EW PTA ❑ ES ❑ PTS Phone # (
) River Basin � 1 t' -(�
-1-0
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body
!
'' (nat>/man /unkn)
Closest Maj. Win Body r / "
ORW: yes /.no PNA yes /,. no.
Type of Project/ Activity
Pier
A
Float
Fing
Groi
Bulk
Basic
Boat
Boat
I Beac
Otht
Shor
SAv
Mon
Phoi
Wan
(Scale:
length
number
avg distan ce offshore—
NINON
max distance offshore-
ONE
ON
NMI
cubic yards
ramp
�i Bulldozing
MEN
"Length
dine
not sure
MEMO
yes
I
ts: yes
n
ON
A building permit may be required by: t
( Note Local Planning jurisdiction) rt
Notes/ Special Conditions ±'
1 k` 1 (,.i
.,'i t \ f (l l t~ '� ❑See note on back regarding River Basin rules.
r'
Agent or AppUcant Printed Name -
Signature, Please read compliance statement on back of permit.;/`
Application Fee(s) Check #
PermitOfricer s Printed Name ,
Signature
Issuing Date;
Expiration Date

i
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, 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 ❑ 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 comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of 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 - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.nett
Revised 08/27/ 14

Y�

N.C.:.DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:I
Address of Property: New ax �e
(Lot or Street #, Street or Road, City & Coun )
Applicant phone #: (oSQ Mailing Address: _Spa :)a+e —Dr.
I\1Pl,)f)c)r+. 1-40_ AR<,r70
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing. with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement net/contect dcm.htm or by calling 9-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.) RECEIVED
I do wish to waive the 15' setback requirement.
DEC 0 2 2015
I do not wish to waive the 15' setback requirement.
_,..., anba- U D CITY
(Property Owner Information) (Riparian Property Owner.lnformation)
Signature Signature
I I YYl I c�_hU m
Print or Type Name
Mailing Address
IBC 5
.�rL—Q
City/State ip
ate - 917-,'�1,5rl
Telephone Number
Print or Type Name
s
Mailing Address
Y V"0.W. , NC, a'�a 3
City/State&ip
;33IP-aaL- q3 85
Telephone Number
Il-aw-aal.5
Date Date

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner. P;Ak `%,O. WPR
Address of Property:
(Lot or Street #, Street or Road, City &
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.) RECEIVE®
do wish to waive the 15' setback requirement. DEC 0 2 2015
I do not wish to waive the 15' setback requirement. D M��q MHp CITY
-
(Property Owner Information)
Signature
Print or Type Name
oog) �PQ
Mailing Address
Weu
City/State ip
Telephone Number
(R' ian rope Ow r Information)
Signature
Print or Type Name
Mailing Address k), " r+ Qc-
City/Stater ip
2-�2 �-o"k- Zs-SI
Telephone Number
Date Date