Terrell, Sean M.

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-CAMA / -1 DREDGE & FILL A B C D
i �, GENERAL PERMIT Previous permit#
New rModification ❑Complete Reissue LPartial Reissut: - a Date previous 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 pursuant to I SA NCAC
EJ Rules attached.
Applicant Name _ Project Location: County
Address j Street Address/ State Road/ Lot #(s)
City — State
Phone # (� `E-Mail Subdivision--------------
i
Authorized Agent '�-�' __ _ City-- m
Affected ❑ CW [I BYtA ❑ ES ElPTS Phone #AEC(s): ❑OEA ElHHF ❑ UBA El N/A Adj. Wtr. Body f ^ V
❑ PWS:
_
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
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 `^---
cubic yards
Boat ramp
Boathouse/ Boatlift ,1T!
Beach Bulldozing^"^''
Other
Shoreline Length f"i
SAV: not sure yes
Moratorium: n/a yes
Photos: 11"Yos n9
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s)
Check #
zip__=
Basin
�j
' `✓ r' 25 ' (nat /man
t
(Scale:► ` )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature
Issuing'bare �— 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 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)
http://www.nccoastalmanagement.net/
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)
Revised 08/27/ 14

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I hereby certify that i own property adjacent to
property located at ao1 `4-:. .�q
T (Address
on (4-, Ifw.: , �. k- . it
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 abjection to this proposal.
I have objections to this proposal.
OF
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RWO
WAIVE gC'T�.,,, IQN
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, ift, or groin j
must be set back a minimum distance of 15' from my area of riparian acc�,ss unto waived by�I ,
a. (If you wish to waive the setback, you must initial the appropriate blank below.)")Y
I do wish to waive the 15' setback requirement. `
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent property Owner Information)
51yn t 1'e rra
14
rat��,til
Print or Type Name of or a Name
9IUM
Date'"
(Revised Aug. 2014)
'Valid for one calendar year after signature*