Jackson, Mark

MCAMA / ❑ DREDGE & FILL N2 70905
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued a'
As authorized by the State of North Carolina, Department of Environmental Quality'''�% ,/
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f
[atftles attached.
i
Applicant Name C r Project Location: County
Address l' ' 1 u +°'r� ' Street Address/ State Road/ Lot #(s)
f" 4' ZIP
City _tip ^�.� �'.- State -
Phone # ( ) E-Mail Subdivision
Authorized Agent City ZIP_
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
I I
Agent or Applicant Printed Na e
Si re Please read compliance statement on back of permit
placation Fee(s) Check #
Permit Officer's rnName
Signature ;
Issui g Date Expiration' 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
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)
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://portal.ncdenr.org/web/cm/dcm-home
Revised T06/ 17

___'):'-"tAMA / DREDGE & FILL 67744 A B > 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 Environment and Natural Resources -711 l ?e6'.
and the Coastal ResourcesCommissionin an area of environmental concern pursuant to 15A NCAC / -Rule
attached.
Applicant Name �fCl' tc �A ItJC Project Location: County
Address
���� : �./► Street Address! State Ro / Lot #(s)
_ _
City _ ;,�; stm"t_ ZIP
_ ,� ---
Phone # (Jt,j � L C,' I E-Mail Subdivision _
T
Authorized Agent _
�A —_ Es - PTS
Affected OE HHF -1H UBA = N/A
AEC(s); -
_ PWS:
ORW: no PNA yes / o Type of Project/ Activity r x, / T' `
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) t
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length---_
avg distance offshore
max distance off".
Basin, channel
cubic yatds
Boat ramp--
BoathouseBoa'liR
Beach Bulldozing
Other C
City ` l C ^' __ zip .
Phone # () River Basin>
Adj. Wtr. Body_ '
�2
Closest Maj. Wtrdy. Bo _
Shoreline Length Jy _
SAV: not sure yes�io
Moratorium: nia yes
l7
Photos: yes rho
Waiver Attached: yes It
A building permit may be required by:
( Note Local Plannfng Jurisdiction) !
Note Special Co diti ns f! 1
� U f� f�c7 {-Gk Cs-t U IA
6`S
Agent or
(Scale:
__ See note on back regarding River Basin rules.
C "4-1", I. = f
td Printed Name
Si �" ease read compliance statement on back of permit #" Signatu
\ �
r --- -- Check # Issuing Dat irdtion Date
Application Fee(s)
N

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT /
/ i ),, el 's
t hereby certify that I own property adjacent to ' / Al pm� of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on
in I' h PC /� G N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lo,qa�,ion.
q C_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
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.
nj iJ _ I do not wish to waive the 15' setback requirement
(Property Owner I formotion) (Adjacent Property Owner Information)
Signature y 1 —/ Signature*
Print or Type Name
Z Ye,
Mailing Address
City/State/Zip 2C`2 _ -7Z3 — e,!�-7 7
Telephone Number / email address
f.7 TA 2ct8'
Date
*Valid for one calendar year after signature'
- 'Ya
Print or Type Name
�u -) nc? C. -
Mailing Address
City/State/Zip
Telephone Number/email address
-11-f`7 -
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
_ (Name o� Prcp�ertV Owner)
property located at
on
(Waterbody)
Y" T s
(Address, Lot, Block, Road, e )
in S ,i�zt� 5 66, N.C.
(City/Town and/or County)
The applicant has described to me. as shown below. the development proposed at the abovea * locon
ave no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMEN i
(individual proposing development must fill in description below or attach a site drawing)
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
Print or Type Name 1 /J/
1 YC
Mailing Address ,
City/State/Zip z _ ��3 - ce F 7
Telephone Number/email address
/7JA�' `r✓l�
Date
*Valid for one calendar year after signature'
(A(dd'acent Property Owp& Infglmaation)
. i cttta•c*
AT�E2i��Iq e4
Print or Type Name
M ili g /�d ess :�
City/S��p�� J��D
Tel h;ne N mb Vlle�moaid, ress
(Revised Aug. 2014)

a�dAMA / ❑ DREDGE & FILL 0 7090 B D
GENERAL PERMIT Previouspermit# ( 7
❑New DModification Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1
j� C3+R'les attached.
Applicant Name # � � C yll ( A Project Location: County 1'i�` C1 I-V
Address —T De' -el c �A V Street Address/ State Road/ Lot #(s)
City ! -; r..; State ZIP
Phone # (, f' E-Mail
} Subdivision f
AuthorizedAgent " City ZIP
ElCW `SEW -PTA ❑ ES ❑ PTS Phone # ( ) River Basin
Affected ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A -/f
AEC(s): f r
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity '
Fixes
Floai
Fingr
Groi
Bulk)
Basir
Boat
Boat
Bea(
Othi
Shot
SM
Mor
Phol
Wai,
A% Wtr. Body .3 ' t na man unkn
Closest Maj. Wtr. Body
(Scale: i )
EMEME
NONE
MEN
MENOMONEE
EMEMOMMEMOMMEM
moll
MEMEMEME
EMENE
MEN
MEN
NEON
ON
MEMEMEM
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
or
read compliance statement on back of permit
Fee(s) Check #
❑ See note on back regarding River Basin rules.
VC .� .
Name
Signs re
f I;,.
Issui g Date Expi ation ate