Witten, Don

AMA / ❑ DREDGE & FILL NT? 67882 A B G1 D
GENERAL PERMIT Previous permit#
evv ❑Modification ❑Complete 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 Resourc s Commission in an arVa of environmental concern pursuant to I SA NCAC '
en"e attached.
Applicant Name ..X2 "II(I i Project Location: County-
Address–
cubic
ountyAddress
State /'"j (' ZIP
Phone # V) . & I A : :'Tmail
Authorized Agent
Affected 7G ' W -B—PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes no,,) PNA yes no
Type of Project/ Activity 6" t�
Pier (dock) length,
�.
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel J
cubic yards
Boat ramp F
Boathouse/ Boatlift
Beach Bulldozing
Other
Street Address/ State Road/ Lo (s)
a
Subdivision
City s <' ," �'= ZIP 4`)
Phone # ( ) Riv r Basin
Adj. Wtr. Body r-"" "' at man unkn
Closest Maj. Wtr. Body—
'I
ody
'?(A
(Scale:
Shoreline Length
SAV: not sure yes no
I
Moratorium: n/a yes . no
Photos: yes no 'k
Waiver Attached: yes no
A building permit may be required by: �- {+ [' ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
f
Notes/ Special Conditions
I
td+�
orapplicant Printed Name
i% PI ase read compliance statement on back of permit
ation Fee(s) Check,#

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
0 Neuse River Basin Buffer Rules
Other:
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/ I -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.nccoastalmanagement.net/
Revised 08/27/14

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No. 1927 P. 2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at _ _ �_3Q �gG�CC,t ��'�•'.
o� � � .� �.�C q jC (Address, Lot, E3
n f
(Waterbody)
own and/or County)
N.C.
The ap icant has described to me, as shown below, the development proposed at the above
loc t" n.
I have no objection to this proposal.
I have objections to this proposal.
Y
DESCRIPTION AND/OR DRAWING OF PIR'O DOSED DEVELOPMENT
(individual proposing de_velpprp2nt must fill in d o y dpfion beiow or attach a site drawing)
Sx/b VJR1K J'
WAIVER SECTION
SEP 0 8 2016
DCM- MHD CITY
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
gg.
back a minimum distance of 15' from my area of riparian access unless w u
wish-to.waive the setback, you must initial the appropriate blank below.)
1z I do wish to waive the 15' setback requirement_ SEP 3 0 2016
I do not wish to waive the 15' setback requirement. DC M® M H D CITY
(Property Owner Information) (Adjacent Property Owner Information)
Malli"Ag Address
GftylstatelZfoQ /! 16.j -�
Telephone Number
Dare
.&' 1? 9 5nr=�
Signature ff
G R Zo 5 a. OFr-
Printr Type N e
- 'hair^ La:!—�,
Mailing Addre 04 r n�
cltyiststerzlp
Telephone Number
C7,/�-l(e
ft, -
(Revised 6192!2092)

- �� � c•JlII►I
z No, 1927 P, 3
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit �6r)
Mailing address:
Teiephon,e Number: '
r
�i I Irl - !CP a
7J�
I cert fy that i -have authorized 6 act. ent/ ontractor),
to.act on my behalf, for the purpose of applying and obtaining all LAMA oermits
I
hecessary'for the proposed development o.r,
at my property located at
T 1..is ce!-L"�ca.tion is valid through. -� _ 2d�6 _ (dak ,
(Property Ownet'Information)
Signature RECEIVED
Print or, Type Name SEP 3-0 2016
Tile, cc, owner or trustee forproperty ®CM MHD CITY
RECEIVED
Date SEP 0 8 2m
9/? DCM- MHD CITY
+'e!eohon.e lNurrmber
tma,i Address kT

.:
Sep 8 2016 2:37PM
No 1927 P 4
A—DJACENT RIPAIM"'1tl
hereby c..rtiYY
that I own property adjacent to
(Name of Proper*' C?tivhe")
prcpe, iv lotted at p -0t, Blo , F2oad, etcAtm
Gadd cess, a
in ptylTown a ±d/or Co�+nty)
Oil (VVaterbody)
- as shown below, the development proposed aL -h-- above
The applicant has described to me,
ioCat 1on I have no objection to this proposal.
�— ro .
I have objections to this p poral_ _ �I ©PMEN r
�— WINI OF
M�OPOSE® DEV"
,v ; ,t6a�1 baso or at�ach a site di-2-ling)
pESCFZIPTION AND/OR�fi6yar
(; .dividjai proposing deve/Pp
f3-
V� K .,Jry
�figAIVE�Z SEicTION
r dock, mooring pilings, breakwater, e
sccess unboathouse, ii.I t. a pier,
of 15' from y rnY area of riparian als
understand that
back, you ��sr initial the appropriate blank below.)
back a minimum distance
waive the set
� Ido wish to waive the 15' Setback requirement-
he '15' setback requirement-
I.,
RECEIVED
SEP 0 8 2016
DCM— MHD CITY
t or groin Mus be Set
w2iVE
d by m=. (i you
RECEIVED
SEP 3 0 2016
Wil to w21ve t o i_;_fOrr''a,Jv
I do raoEw
Pro erty Ow' e'
(propE Qvy�or rronatoon�
Si anC«
C V
pri,j t. q r TYPe a�Prne
2,r Nc
Me1p , Address -7 I a
Cry/S. eta2�P l _'5 yl
Ta/zphona Number
IN
(Adac
� r
print or TYP
Addre s -• G- 7
M^iW g
City/Statip
Telephone Number
Dare , p,
MA

✓1 lu
16' wide navigation route
Existing remnant 22'
Proposed replacement len20' ®d oftform

i
rlc��
e
ADJACENT RIPARIAN PR®PER A Y
I hereby certify that I own property adjacent to (NaMe of Properly Owner)
property located at(Address, Lot, Blo�, Road, etc- l � �i C
1 e day
on
h1in (L fE i/Nown and/or County)
(!Iliater�odl)
proposed at the above
I h ap 'licant
has described to me, as shown below, the development
loq�t I have no objection to
this proposal.
—�— 1. haue objections to this proposal.
ncFn nPVEL®PIVIENT
- --
^
breakwater, boathouse, lift, or groin must be set
ooring pilings, me. If You
f understand that a pier, dock, area of riparian access unless waived by (
back a minimum distance of 15' from my ro riate blank below_)
wi�h-to waive the setback, you must initial the app p
I do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
(P. operiy Owner Information)
SiG �atv '
Print or j ype lame
idilf Address n -7: ( a
Ciy/statell-ip 1 to
—on eNumber
Date
(Adjacent ProperEy 1. v -1-e ue aur•••• —
Sig�atvre a "S 9-
GRZ
Print 1or 3�e Ne40-A-/�
Mailing Addref� n j',r
City/statemp q /() X 3 0 3 7 t
Telephone Number
��12_C�pc ®�
Date n "C I �i E ®
(Revised
St��a/� 016
DCMI- MHD CITY

1
0.
AQJ CENT RIPAMAN PR®PER o °P
1 hereby certify that I own property acent to
adjacent (Name of pr®�raeroperty )
t 3q �Q �-
prgperty located at (address,®t, �Io , Road, et N.C.
f���� in QC.�
on' 1 Cu /f®wra asaci/or Couc�fY)
(Waferbody)
proposed at the above
ap m
licant has described c�scribed to e, as shown
below, the development t n. proposal.
I have no objection to this pro p
�- 1 have objections to this proposal-
DESCRIPTION AIV®/®R DRAWING OF
proposing level®pment sanest loll it ?ion belowor aftac, a site drawing)
I p,�o p
T A
�-r s cep .1�-- •- -
--f
(a} 11VER SECT8ON groin must be set
ier, dock, ooring pilings, breakwater, boathouse, lift, or 9 me If ou
I understand that a p area of riparian access unless waived by ( Y
bark a minimum distance ooUus Helsel the appropriate blank below-)
wi-th to waive the setback, y
I do wish to waive the 15' setback requirement-
_ I do not wish to waive the 15' setback requirement.
(P
pew owner Information)
Pr � or 1 Fyp e
t �
Nair Address
Cit/Ste te2rp n f � � 5
i e(ephone Number
(Adjacent ProperLy
Sigr�aty-re � r;
G R Za �S
Print 1or 3�e Ne
Mailing Addre
n '
City/State2ip
Telephone Number I
Date
REC
(Re§ 0cy 6f2)
®CM- MHD CITY

GENT AUTHO
FORM FOR PERIVI[T gPPLIC TONS
f in for Permit:
Name of P-operty Owner App Y g
NS�iling address: C ?-71 �Z?
n .
i =! ephone Nurnber:
have authorizedEIU INorr[ r [�� (agent/contrac�or),
f ` r^{� • 1 ' LQ4� '-e' '`fin
! crify that . na J tom.
�t on my behalf, for the purpose of applying and obtaining a!1 SAMA ��ermits
�o ,ate
ne
�I e,.ssary nproposed development cr
cfor the
a my gropery located at
:;;5 -ef-t ,;ca;ion is valid through.
(d ate.)
i
(P ode.ty
Own er,Information)
Signature
i
Prin` or Type Name
co, owner or trustee for property
Date
-�ephon� Number
1.ddreSS
RECEIVE®
SEP 3 0 2016
®CM- MHD CITY

R Y
°O��E
PER R�� PH©a � S
�
�Dd�CrNT R6P� ° s
cent to
he eby Ce-, I -y that I own Property J a
ad �C(J
� �, EtcU�� n N C.
L -©d, BB© /ILiL
--------
''LY loc2�ed 2T ���g�@�ess, Q
�� �� �C in a"Cuor C©��iy)
�-
on �� she above
Cfatey tbodY velopment proposed _
olicant has described to me, as shown below, the de
The, ap,
I have no J
iocar!on objection to this proposal.
I
objections to this proposal- i
I have ob1 FVE-®�'-'M-E
t
' 9P�G ® 3P ®SC© ®- 0, Ch a sate
�ESG[�!P �loN ANA)/®R DW r _ _ ,;;tion sbelo r
`fa �>opos�n� de'.�edop��; Mn�sf �.�� vrr '• f -��,.
�I Ir
SECTION lin, or groin mus_ be set
i8G�B�EP �i you
mooring pilings, breakwater, boathouse, waived by , n=
A Pier, dock, area of riparian access unless
ul {cerstand ghat a p ro ria'ie blank below.)
back a .minimum distance of 15' fro ti
aive the setback, You 'nu
a�aa�aa9 the app p
�,✓is(�t
f do wish to waive the 15' setback req uirement-
IVI� irementi.
CIO -.lot wish to waive the '15' setback requ
L e�6oP�3e, ©y�n.e'
L'e"�-FprE-i2teOn)
-,. Qw er 1EITOFl-
�"a o©��
D c.
e dame
1
(Ad3ac
fV
Print or Type
Name
i
MAddre s
aifCPZ-
r� c N
City/State17j
eiephone Nu
,bare
®CM— MHD CIT`