Peterson, Allan

NCA,M A El DREDGE & FILL
GENERAL PERMIT Previous permit #
- j New ElModification El Complete Reissue 0 &]e is s u e 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 pursuanvto-L5A NCAC j IT,
0 Rules attached.
nt I e 0'. -ProjeMrocation: County Applica' Nam 'I i
Address 171 j Street Address/ State Road/ Lot #.(s)
Ci 1 State LU�. IP
Phone # Subdivision
,.Authorized kent Ci
El CW )�EW VPTA DIES 0 PTS Phone #
Affected El OEA 0 HHF 0 lH 0 UBA El N/A
AEC(s): Adj. Wtr.Body
0 PWS: E3 FQ
Closest Maj. Wtr. Body
ORW: Crit.Hab. yes ye 0 1PNA yes /(no,,, no yes
Type of Project/ Activity
- Pl.tf
Fing
Groi
Bul
Bash
Boat
Boat
Beac
Oth
Shor
;SAV:
S and and
Mo
Phot
,Waiv
- i I /.— fir./ )
(Scale:
MEMO
MOMMERNMEM
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my
building permit may be required by:
E]See note on back regarding River Basin rules.
Notes/ Special Conditions
N

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, 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 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/ 1-888ARCOAST
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

=tom.- V, 10 EJ), i Hnba
Applicant:Ozn
Date:
Describe below the HABITAT disturbances for the application. All values should match the na e, and um of me su ment
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance•total
includes any
anticipated
restoration or
temA 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 0 Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ . Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑

PROPE
I hereby certify that I own property
f�
prokrtty ocated at -&I—
on
(Waterbody)
to
(Name of Property Owner)
(Address, L lock, Rp,,d, etc.19
in A JL ( C -UCH , N.C.
(City/Town and/or County)
De a icant has described to me, as shown below, the development proposed at the above
#V-0ca ' n.
have no objection to this proposal.
have objections to this proposal.
ESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPME
(Individual posing develop nt must fill in description below or attach a e wing)
�0�� -�
a
N �P �
WAIVER SECTION I
I understand It a pier, dock, m oring pilings, breakwater, boathouse, lift, or grain must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
06 wish.to aive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjac t Property Owner Information)
Signature Sign e
te t,—
o-c-k
Print or Type Name Print or Type Name
Mailing Address Mailing Address
City/State/Zip City/State/Zip
Telephone Number Telephone Number
Date Date
(Revised 611812012)

D&S CRIT' ►l'fON ND/OR DR ►WING OF PR1..1 POSED DEVIMOPMENT: I
I -O be fi f !ed in by pry, I erdy pawner prni ring d¢velMjVb
o G
v c� OCT 22 2013
fly DCM MUD CTTy
die
�S '�/ Y6 e
d L `
A-
�`
b
A lfW,, .I: 'ENT 119PARIA11 PROPERTY ONMER S':II'.A TEMEN)<'
c
I here -r certi .y that l :iroper. i adjacent tom"` � - a� �-
�51 �I ` - . dame of Prof► :rty er)
rh . locs�ted R(r t�, � a�, f a G ca
P Ierty
(L It, Block, Road, tr.)
on 2-sinAaA;((�� C� N.C.
!S�(«'. terbod;) ('T .iwn an r Ci aunty
Aoplicant's phou;, �G 1 Mailing Adc •em: I� ,
re X/ S
i4e. has de..qcrihed -V me, as :1own below the developmety .te is proposinji at that location, and, I
have no objections ,) his pr,)posal.
7'
. V
_l
(Tnformatiom fi)a•i'itiper't7,' C'vwner,A, li1;Iiag (Riparuu. 'roperty Owner)information)
for Permit)
3- 61NI�%gym
Mailing Address y Signature
wee v� l._(� � C�� �a•_ �
�� i Print or T Name
City/StatetZip 3`Pe
a- 7--Q 2i-7-�-' T�----
Teleplzone
Telephone Number]
Date

F1UJ/1lrC1V 1 MrIMMINIV rMirr-M IT VYYIV CR J 1 N I CIVICIV 1 j
I hereby certify that I own propert adjacent to 6 i ap / if/
114 S
(Nam of Pr erty Owner)
property located at a a� ti wq C�
A(Address, Lot, Igc , ad, etc.�^ !
on S (i , in /c��yi �C'_ err , N.C.
(Waterbody) (City/Town and/or County)
The applic t has described to me, as shown below, the development proposed at the above.
locatio
I have no objection to this proposal.
(in
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
pro osing developmenj must fill in description below or attach a to wing)
GSe�/
>ECMVM s
�cy
OCT 2 2 2013 _ , �.
red DC:d•:1:SD C
pp
Q WAIVER SECTION
I unc arstand 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.)
do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
(Property Owner Information)
Telepho a Number
/1 12
Date
nt Prope , _ per Irformation)
P�n� T�pe ame 1 O �
Mai�'n Address e j ``� 2 gG 2
City/state2ip
Telep one umber
-0 af
Dad
(Revised 611812012)

i iot t i s arrilincr
Pat McCrory
Governor
Date ° O — .
ALIT,
^VA
wN..�.
14CDENR
De�-+ tmert of Environnnert, aril �jlatura r'�.1solJ'rcas
Division.)I Coastal Manag(onent
Eraxion C. Davis
Direci0r
Applicant Name
APP — --
Mailing Address�-
cl— I-
Joan L. Skvarla, ill
Secretary
£laz 9 9 130
tm3v
/,c/ _
I certify thati I have a ith, Ariz ed (agent) . to act on my behalf, for the
purpose of applying 1 br :md obtainiag all CANU Permits necesE ary to install or construct (activity)
��` 1� b� , at (location;
P1`4f/
This certifica n h va lid thru (date)
Signature
400 Corhmerce Ave. 10o: shead City, NC :!8557 One
Phone: [phone]- -1 F, ,X: 252-247-33" ) Internet: www.r xoastalmanagement.nr+l Nor/r�htCa/r%olina
An Equal Opportunity % AM TWBU Alic: i Employer f/ � %atUA 119

94
d
MEWED
OCT 2 2 202
DCIA I IHD CITY `

INTRACOASTAL MARINE CONSTRUCTION
3515 WHITE DR. 3145
MOREHEAD CITY, NC 28557 66-112/531
Date _6 �ce(C fJ
4
Pay to the � V (o'o
Order'@ r
vomrs
BRANCH BANKING AND TRUST COMPANY
. I400-BANK BBT BBT.com
.FOR "Jai 6P
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