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JZ�4tAMA El DREDGE & FILL
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"GENERAL PERMIT Previous permit #
�,NlNlew ElModification ElComplete 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
DIkules attached/
41,�
Applicant Name Project Location: County_
0,
Address C0�
Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # �,,'""F-Mnil Subdivision
Authorized Agent
Affected 0 Cw �w A -PTA DES 0 PTS
AEC(s): D OEA 0 HHIF 0 1H 0 USA ON/A
D PWS:
COW yes J, no.-' PNA yes
Type of Project/ Activity
Pier (dock) length i"',✓
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore -
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
City ZIP
1 1
Phone # [liver Basin LIZ, 7A
Adj. Wtr. Body- rhai /man /-unkn)
J
Closest Maj. Wtr. Body
Beach Bylldozing
Other
Fr
Shoreline Length
SAV: not sure' yes no
Moratorium: n/a yes
Photos: yes
Waiver Attached: no
/O
C
Abuilding permit may be required b,, Y (-q
(Note Local Planning jurisdiction)
Notes/ Special Conditions A !
N.
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A le L icn!�,,
1 41N
Agent 'I t Printed Name Permit Off
Sig ature�
PlWse read compliance statement on 4back e It SignatuTe
'- PIP
Fees) ss
vij D;
(Scale: i
❑ See note on back regarding River Basin rules.
n
Printed Name,
E
mticin:Date
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:
0 Tar - Pamlico River Basin Buffer Rules 0 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-411COAST
Fax: 252-247-3330
(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: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastalmanagement.net/
Revised 08/27/ 14
rCAMA / ❑ DREDGE & FILLM 67718A B 'rC D
;E�NERAL PERMIT Previous permit# --"
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC�r
pies attached
t Name S;J Project Location: County
Gpil,
*_ Street Address/ State Road/ Lot #(s) 3_ _
State , ZI4
E-Mail Subdivision
;ed Agent "�... City ZIP
❑ CW CW „'PTA ❑ ES ❑ PTS Phone # O River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A �»
Adj. Wtr. Body ' nat an unkn
❑ PWS:
yes o PNA yes no Closest Maj. Wtr. Body �'✓'—' �`
f Project/ Activity € f '` �° � ,r I r �,
■
vg distance offshore
oil
channel
MIN
MM
Ell
)Ic yards
mmmimm=mmmmm
MEN
ONE
1_111111MIM
MMMI
ME
No
11111101IM1101
NEON
---IEEE
IN
mommomi
MOMEN
41IMEMIN
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to YYL Ak;k�- 's
Name of Property Owner)
property located at l L it �( .S'i �i� �j�c
Kc-
(Address, Lot, Block, Road etc.)
on K3 o 6 Gcrr1y in 9.exF'& T- , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
fie� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
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.)
RECEIVED
do wish to waive. the 15' setback requirement.
JUL 18 2016
I do not wish to waive the 15' setback requirement.
(Property Owner Information) . (Adjacent Property Owner In r on
® CITY
Signature
Print or Type Name
.I I �i S Af Zif& IQ A7�c� f�i'cjl
Mailin Address
tqc,�- J"V . PArei
Cit /State/Zi
sz.- Y a— s�S�
Telephone Number
Date
Signature
Ch,& p l �s
Print or Type Name
1 t 3q 8, I ter Pk -
Mailing Address
1/34
City/State/Zip
Telephone Number
7,Q-,)q/ -017q 15
Date 6' `o _ io
(Revised 611812012)
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: /' A p - 1C&&T £ &
Address of Property: t aq S * c 'T e& p,att,' Merl- SitcaocAm nz .a"4
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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 pr osing. A description or drawina, 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 http://www.nccoastalmana_aement.net/web/cm/staff-listing orby 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, boat ramp, 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 w tie setback, you must initial the appropriate blank below.)
I do not wish to waive the 15' setback requirement. JUL 18 2016
EMM ® CITY
(Property Owner Information)
Signcfture
YYi,0 1 k � fz
Print or Type Name
C,I,ZY S,4e- Gr eort4God
Mailing Address
-,�e,r f a /,t pi r a a la
City/State/Zip
Telephone Number/Email Address
6-3-146
Date
(Ripafi4n Property Owner Information)
Signature
Print or Type Name
Railing
City/State2ip
R15 3,71, - 3S 3 �--
Telephone Number/Email Address
fo iif-/7D Ic,
Date
(Revised Aug. 2014)