Poole, Jr., James H. (2)

SCAIVIA El DREDGE & FILL
C
tL
ENERAL PERMIT Previous permit #
C 66467
ew
A B
E)Modifi'cation OComplete Reissue 0 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�i an are Prof environmental concern pursuant to ISA NCAC
[:1 Ruleg attached.
L
�c
Applicant Name ject Location: County',,
Address,- Street Address/ State Road/ Lot #(s)
(A
1 1
CityState zw-
"7
Phone # E-Mail Subdivis.iop
Authorized Agent"-_
Affected 0 CW �EW _� IPTA 6"ES El PTS
AEC(s): 0 OEA 0 HHF DIH 0 UBA 0 N/A
0 PWS:
ORW: yes / 10?"; PNA yes ono
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)A�
Groin length
number
Bulkhead/ Ripr-ap length
ayg distance offshore
max distance offshore
Basin, channel
cubic yards—
-4�
Boat ramp
Boathouse/ Boatlift ......
Beach Bulldozing
Others t
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: es no
s
V Waiver Attached: es no
no
A building permit may be.req uired by:
Note Local Planning Jurt dicti
Notes/ Special Condition
City fr
JI Phone #
Adj. Win Bodis
Closest Maj. Wtr. Body
1�. k
ZIP
River,
Basin
-I r Innt
(Scale:
See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Permitotice r's;Printed Name
Sig64iqre_.
eread compliance statement on back of permit"
Signature
fe
Applicatiopf.pie(s)
Check #
Issuing .pate.
Expiration Date

fl
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 how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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.net/
Revised 08/27/ 14

ADJACENT RIPARIAN PROPERTY . OWNER -STATEMENT
.(IndlividUal proposing
in clesqr1prion veto ®r duatill a 0160 U1 avirilivy
WAIVERSECTION j
I understand that a pier, dock, moo6r akWater, boathouse, lift or groin must.be set
ring pi ings,
nimurn distance of 15' . ftom my- area of.riparian. access unless waived by me. (If you
back a ml
isp towaiye-
w the setback, you mus.. initial the`appropriate blank below.)
I do wish to. waive'the 15' setback requirement:
I sh to waive the 15' setback requirement. do not wi
(Property Owner Information]
ation) (Adjacent Property Owner Information
Me2
re
/4 qtu7 �re
M
Or I VD8 NaMO
Addross
Cifylstatelz- f io U�
Telephone Number. Teleph—one Number
Date Date
(Revised 61161201.2)

ADJ�CENT RIP RIAN PROPERTY OWNER STENlEIVT
I hereby certify that.l own property adjacent to
�roi� lo.. t .S7" cr (Name of Pro s
t0d4ai `� _ N Property Owner)
�r..�r ). �.: _ -.,•.� 1. �:
(Waterboc9Y) in N.C.
(City/Town and/or Coun9 ) a
The applicant has described to me, as shown below, the development proposed of the above
— 44;_._ , 1lave no oojection to this ro
p posal..
--- I have objections to this proposal. . .
DESCIZlPT'ION i41VD/OR t�RAVWN, G, OF (PROPOSED DEVELOI�MENT
wd..w wTdw .J.....w..w...l
R.E C
DEC 15
4 DCM- MHD CITY,
MUVER.SECTION
yZ,:wtvat�rraavlt wvaN.tvuap, qll, VI 1J.IV111 !1lI,lJL.UC,��
back a minimum distance of 15, from m .`area of riparian.access unless waive
wish to waive the setback, you gnus# init! the a appropriate blank below.
d by me. (!f you
pp p ow.)
--: I do wish to . quirement.
waive the 151' set
back re
i cao not wish to waive the 15' setback requirement.
(Property Owner Infonnatlon)
�Pnnt or Tjipe Name fcl} tA i �,.1 q
Mailing Address -
45
�/ f
telly110ld a/Llp F
g rA 3 ;.tr9
Telephone Number
Date
�-�•9ig•�'G? 6,23P�
(Adjacent Property Owner Information)
i
/✓/�,K664i/ G .�
�lU2fl4 C bLAJ C. �Snu
r'rint or T e Name617
Maili Add_ Jr _
cltyrs,tatelzip
Telephone Number oZ7
Date / -
12
(Revised 6/10012) : r
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RECr-"VED
DFC - � 2015
CITY