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4 1•CAMA/ -DREDGE &FILL C—.�
GENE14L PERMIT Previouspermit'#
ChNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date pre" u 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 pursu nt to 15A� NCAC
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Applicant Name. ,.. ' -.�,; t ,i � x ,' ;; i ..t �t ' i „ Location: County
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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 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 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 Washington District
400 Commerce Ave - 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-8884RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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.nccoastaimanagement.net/
Revised 08/27/ 14
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LAMA/ 1 1 PREDGli& FILL
iENEFiAL - PERMIT Previous permit#
4.ew ❑Modification ❑Complete Reissue OParlial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources
5astal Resources Commission in area of environmental concern pursu nt to I NCAC
1, j' j I s attache .
Name-'`r t j' ; '� > i�` ~ P"roje jct Location: County . i,
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'ant Printed Name
PermitOfficer's Printe Na
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ePlease read compllance statement onback ofpermit** Signature �x
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(s)
Check# Issuing Date
Expiration Date
A
I hereby certify that I own property adjacent to rg)e��_-V'�_'4:A Is
(Name Of Properiv Ovirned
property located at C-A t-1 15r. / 'k'^ A
(Address, PA Block Road, .)
on A/A 4 jnfA7'4-AA.,yg.c__ , N.C.
(Waterbody) (Cfty1Town andfor County)
The applicant has described to me, as shown below, the development proposed at the above
lots oca�_ I have no objection to this proposal.
I
I have objections to this proposal.
DESCRIPTION AND16111 DRAWING OF PROPOSED DEVELOPMENT
(InAddual proposing development must SH In dewdpfibn below or attach a site cknWng)
C . I.- )P�yc_?A VA'%y
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 16 from my area of riparian access unless waived by me. (If you
wish -to waive the setback, you must Initial the appropriate blank below.)
Awe
I I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback requirement.
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Print or Type Name
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Mading Addrep
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Telephone Number
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2017
WIHD CITY
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APR 13 2017
DCM- MHD CITIA
14
I hereby certify that I own property adjacent to lieAtr;;tv t� A ywx
C � (Name of P Ownerv,
� sA`
property located at
_A - 11 A
(Address, �ot, Block Road 9W
on WA f- in A'Ir4. Atyzl <�, V 7;� 4C.- N.C.
(Waterbody) (CItyrrom and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
I DESCRIPTION AND16111 DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in desedp0m below or attach a aNe drawing)
K.1
A
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5T_#\C_'VE
Z4 (A - AIe.-
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or groin must be set
back a minimum distance of 16 from my area of riparian access unless waivoo
wish -to waive the setbacK you must Initial the appropriate blank below.) MgCfE("V
I do wish to waive the W setback requirement. MAR 3 0 2017
✓ I do not wish to waive the W setback requirement. DCM- NIHD CITY
§A_11___� Property
Jf%WJQ%M11& Owner Information)
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Name 17n, or Too Name .71�""e /a, v/4— RaiRECEIVED
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APR 13 2017
C#y&YaftqD CRY/Stib/zo
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To" Number D C M HD CITY
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APR 13 2017
DCM- MHD CITY
MAR 3 0 2017
®CM- NIHD CITY