Outlaw, Tom & Debbie

All
-J N. J
4CAMA 1:1 DREDGE & FILL
GENERAL PERMIT Previous permit # El op.. q�4ew ❑Modification ElComplete Reissu 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 I I J 11"OL"')
lkulesa ched.
J, Applicant Name I Project Location: County
Address Street Address/ State Road/ Lot #(s)
1-1
CityState ZIP 2 Phone # (-I 0) Fax # Subdivision
Authorized Agent c i City,
-x )
Affected PIFW W X4t T 0 ES 0 PTS Phone # I-)
AEC(s): 0 OEA 0 HHF 0 1H 0 UBA 0 N/A Adj. Wtr. Bod
0 PWS: EIFQ
Body-
- Closest Maj. Wt
4� PNA Crit.Hab. yes no r.
ORW: yes/, � Co yet / no
ZIP
River Basin
16nit /man /unkn—
Type of Project/ Activity N."-. V k I
OMEN"" ENNOMMEN
MEN
LOSE
MEN
■■■■■.........,u■..1,.........MEN
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MEEMEMONNEM
6—NO"NKIONNIZE
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ONMEMENNE
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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
landowners).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythatthis project is consistentwith the North CarolinaCoastal 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 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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 2855.7
Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

lik •``.i 'S7n S :i 13-v�="hm2 RAM- Y � Ii�t.,:Jv_ � k��r.],., .7 �' =�. "I
Applicant:\_�
Date: 11
l�
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 Q Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other (
yqo
Dredge ❑ Fill ❑ Both ❑ Other
D
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 ❑
252-M-lava :. 'd-3z&4RCQA a

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to —FoW� k "�P- 's
�qa \. 't;A C�l< Uig- (Name of Property Owner)
property located at
(Address, Lo Blo k, R ad a .)
on ��1,`S Creek , in o i , N.C.
(Waterbody) (City/Townand/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
_'IX I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing developments' must fill in description below or attach a site drawing)
CSee. ��� � 0-cwJ trJ
OCT 22 2013
DCWNHMCMY
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.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement
(Property Owner Information)
Suture
Print or a Name
lk400 & Cam- U_ 1*
ling dd s
Cc C~ 2855'�
/St / .
ephone Number
Date
(Adjacent
Signature /
�Yt.t,t '-e' A,/I
Print or Type Name
I.YUv Ia,'�l s 6), re k
Mailing Address
City/StaterLip
Telephone Number
/i vcf
Date
(Revised 6/1&2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to �a►M k 1e"0- au, 6M 's
(Name of Property Owner)
property located at
(Address, Lot, Bloc , Ro d,�%`
on ��A'6 C-MP-k , in o N.C.
(Waterbody) (City/Town a or County)
The applicant has described to me, as shown below, the development proposed at the above
to
` 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 drawing)
d..
OCT 2 2 2013
DCM MHD CITY
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjace Property Ow
.Signattt� �IA�Lq.ld� SI 6
Prin or T e N m Pri f o T Na e
A ""W6
/St te/Zi Citj�/State
�z 2
Te phone Number Te phon Num er
Date Date
(Revised 6/18)2012)

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