Chiles, Robert Jr.

A
CAMA / ❑ DREDGE & FILL Na 70410 A B C D
GENERAL PERMIT Previous permit#
[-]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the'State of North Carolina, Department of Environmental Quality -7
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached.
Applicant Name -
Address
City = ..,_ / 3 $ ZIP .
�
Phone # (,' Xr E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ElHHP ElIH ElUBA ❑ N/A
❑ PWS:
ORW: Yes / no PNA yes / no
Type of Project/ Activity
Floating Platform(s)
Finger pier(s)
Groin length
number r
Bulkhead/ Riprap length
avg distance offshore
max distance offshore i
Shoreline Length
SAV: not sure yes /d(
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions __j
t
Agent or Applicant Printed Name
Signature* Please read compliance statement on back of permit
Application Fee(s) Check #
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
CityZIP
Phone # ( ) f� River Basin
Adj. Wtr. Body `� % +` f �� (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale:
["See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature JN-Piration
Issuing Date 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:
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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/ 17

1!
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t'Z .bcwtir < Al Ml C""':= I
(Name of Property Owner)
property located at lt. l2 e.n-6V*J S Q-A%Lc�s 2'
(Address, Lot, Block, Road, etc.)
on N¢vic 1akvv - in NCW STUN f C17AVLni Co. L N.C.
(Waterbody) (City/Town 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Z 'D (LR+s ►;J 4 s (rr-rf <A"V
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.
(Property Owner Information)
Signature
IZdbs^yt M
Print or Type Name
Iut, cAV--j SVM�Kts eo
Mailing Address
NcJ I3e", Nc ZPISIs O
City/State/Zip
o`-
Telephone Number/email address
3rn" 1
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Signature
J A s.,v Vvy cc--
Print or Type Name
Mailing Address
f-4 tiu Oe" , PLC t8srC a
City/State/Zip
Telephone Number/email address
3tRaIi H
Date *
(Revised Aug. 2014)

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EXISTING DOCK
1208 GREEN SPRINGS
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15' RIPARIAN SET BACK LINE
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EXISTING DOCK AT
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OVERALL SKETCH PLAN
FOR
The CHILES
1212 GREEN SPRINGS ROAD
1"=100'
CHANNEL, ADJOINING DOCK, AND PIER HEAD LINE FROM USGS AERIAL PHOTOGRAMETRY
BOUNDRY INFORMATION FROM SURVEY BY ROBERT M. CHILES PE

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�0 85.08' 20.00' 15' RIPARIAN SET BACK LINE
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o� RUBBLE
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63,3'
3 I 160,0' CONCRETE PIER 9.0'
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48.53' v 38.28' j
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PROPOSED DOCK LOCATION SKETCH
FOR
The CHILES
1212 GREEN SPRINGS ROAD
1"=100'
CHANNEL, ADJOINING DOCK, AND PIER HEAD LINE FROM USGS AERIAL PHOTOGRAMETRY
BOUNDRY INFORMATION FROM SURVEY BY ROBERT M. CHILES PE

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 'kLlaew ie*,o A-Pj Ct{iwa s
(Name of Property Owner)
property located at t2lZ CtAAW SPR.sMr%S DLO
(Address, Lot, Block, Road, etc.)
on Ntsuf� it,tytsx. , in Now WAAJ, C"-,r'mu Co.$ N.C.
(Waterbody) (City/Town 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
2 Oka-e0 "-;irJ J
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 Owner Information)
Signal ure
T M C
Print or Type Name
izit ctuaw SSNLJI�gs tO
Mailing Address
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City/State2ip
ZSL-4}0-1,4g4 � Re�'eErobca>nnc.a�t,�pe.ci�.
Telephone Number/email address
3(y1 Ay 19
Date
*Valid for one calendar year after signature*
(=pert Owner Information)
SignaLh Y AE1
,4 /ti
Print or Type Name
i3Oy C'A.e" t'Pa-►NU RA
Mailing Address
niw '3s'<w t WC- - "SG. b
City/State/Zip
Telephone Number/email address
3MAI t IR
Date*
(Revised Aug. 2014)
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