Slavin, Edward

)"MA El DREDGE & FILL
NO* 67043 A B D
�C
GENERAL Fn-)= R M I T OfAjed—A L- Previous permit #
E]New El Modification omplete Reissue El Partial Reissue Date previous permit Missued =jl(,,
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in4n,area of environmental concern pursuant to 15A NCAC
Rules at* !ched.
i'Il, (`
Applicant,Name ,]S' 1
2
-4roject Location: Counity;L
Address -21,11),q, /%
Street Address/ State Road/ Lot #(p)
City i State"�V ZIP
Jv
Phone # 5-4-Mail
Subdivision
Authorized Agent
City ZIP
E] Cw W *A El ES D PTS
Phone # River Basin
(Aj
Affected
DOEA Ll HHF El 1H El UBA El N/A
AEC(s):
Adj. Wtr. Body- A
(nat man /unkn
yes ORW: El Pw,�-, yes PNA
A
Closest Maj. Win Body J)

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
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 consistentwith 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
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

Y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to eIV11 d r� W - � la r / V1 's
h
property located at C4 I WSo" (Name of Property Owner)
/ (Address Lo�6to I�RA t
on �Ao� h P CS V L , in C.�a �'JCV� O U PIT N.C.
(Waterbody) (City/Town and/or County)
The appli nt has described to me, as shown below, the development proposed at the above
locati
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' descr"ption below or attach a site drawing)
RECEIVED
SEP 21 2015
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.
f
�I do not wish to waive the 15' setback requirement. D�
q I�
(PronArty qwne f rmation) (Adjacent Property Owner Information)
Sigrru#atre `,,. S f a v i Signature
Prin Qr4' (V me (7041 C -
MaiftAdds
cityist) - toy (' 8 2'&.0
Telephone Number/email adAess
I -)Jr tots
Date
*Valid for one calendar year after signature*
Print or Type Name
Mailing Address
City/Sta te2ip
Telephone Number/email address
Date *
RECEIVED
SEP 2 3 2015
(Revised Aug. 2014)

w
ADJACENT RIPARIAN PROPERTY OWNER ST�AT/'EMENT
I hereby certify that I own property adjacent to F W a � s
property located at t 4- J4e,&AS01V1 CT- (Name of Property Owner)
(Address, LotAck, ad, e�c�
on �� we � S Cr.�� in C._-Q V-od-F l `nL(. K iy , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
local
tio .
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)
%2 "ALq,
A-.,ic-ca cA
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.
(Pro erty Owne formation) (Adjacent Property Owner Information)
eew M.
s�
SY99W 51- AV
IN)
Signature
Print)0 U Typ Nff4vame t- M JTt I Ae, �L Print or Type Name RECEIVED
--� L,u r'tdipss ,e Q' j /+ JI )4rj� Mailing Address SEP 2 3 2015
Ctty/'�iate
7p G3 �� City/State/Zip a r+a
Telephone Number/email address Telephone Number/email address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature'

CAMA / REDGE & FILL
ENERAL PERMIT
Previous permit
ew. ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by a State of North Carolina, Departm t of Environment and Natural Resources I ;
and the Coastal esources Commiss' n ' area of enviro e�ntal concern ursua to 15A NCAC )'Vgt�
ules attach
Project Location: CounA Applicant Na z &' ty
Address ` ' } treet Address/ tate Road/ Lot #(s)
Cit)v� State ZIP f
Phone # t
E-Mail Subdivision
Authorized Agent---" City :^ •{� ZIP 1'
CW
a1�EW PTA ❑ ES ❑ PTS
4hone #❑
Affected
erBasi
❑OEA ❑ HHF ❑ ugA ❑ N/A Wtr. o na man ( u k�n❑ PWS: ~ .
Closest Ma Wtr. Bod �F
ORW: yes / no PNA yes / 0 1 Y
4 IQ
F-Pip-r
of Project/ Activity
(Sale: )
(dock) length'`-.---
.
Fixed Platform(s)
Floating Platform(ir
Finger pier(s) ----
Groin length
number -- ---
Bulkhead/ Riprap length---
avg distance offshore"
max distance offs
hannelB cubic yardBoat ramp t
Boathouse/ Boatlift—
Beach Bulldozing,----.
Other `w
Shoreline Length �^ �✓ :/
SAV: not sure yes no
Moratorium: n/a yes )po--
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction.
Notes/ Special Conditions C(1
❑ See note on back
)ct'�
River Basin rules.
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IN