Taylor, Donnie & Wesley

I✓
❑CAMA / J DREDGE & FILL
N2 72037 A B C D
GENERAL PERMIT
Previous permit #
E]New -Modification ❑Complete Reissue El 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 I SA NCAC
Rules attached.
Applicant Name_
Project Location:
County
I
Street Address/ State Road/ Lot #(s)
Address
State ' ZIP'
City
Phone # ( ) E-Mail
Subdivision --
-- -- —
—
Authorized Agent �-- --
City
CW � EW )(PTA El ES [IPTS
Phone # O
River Basin _
Affected El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
�—
_gnat /man /unkn)
AEC(s):
PWS:
Closest Maj. Wtr.
Body- --
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length t -1ry
Fixed Platform(s)
l
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
Beach Bulldozing
Other�Y'�t
Shoreline Length Lill
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: " = i') {
( Note Local Planning jurisdiction) r
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit"
Application Fee(s) Check #
/1_ �
(Scale: _ -
❑ See note on back regarding River Basin rules.
Z,4� fa
Permit Officer's Printed Name
Signature �
t Issuing 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 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/ 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)
http://portal.ncdenr.org/web/cm/dcm-home
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 7/06/17

"CAMA / ❑ DREDGE & FILL N® / 2037 A B r' D
GENERAL PERMIT" Previous permit #
]New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attach .
Applicant Name �` Project Location: County i.'
Address, Street Addr sq 'State Rpad/ Lot #(s)
City �. State ZIP.
i
Phone # ( Ti ail Subdivision ----' .
Authorized Agent
Affected r_ w *w
AEC(s): ❑ OEA ❑ HHF
❑ PWS:
iV"TA ❑ ES ❑ PTS
❑ IH ❑ UBA ❑ N/A
ORW: 'yes J no PNA yes /
Type of Project/ Activity
c;
Pier (� '�
Fixed
Floati
Finge
Groin
Bulkl
Basir
Boat
Boat
Beac
Oth,
e
Shoi
SA\
Mor
Pho
Wai
Phone #
Adj. Wtr. Body a
11
Closest Maj. Wtr. Body
Basin
(Scale: I 11r )
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NNMO�iO1MM.IK�1■llrMNrN■HMO■■O■Mlrin■NMENrO
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A building permit may be required by:4.,,fT�`fL�,,
( Note Local Planning jurisdiction) `_
Notes/ Special Conditions
Agent or Applicant Printed N*ne
! % 4
Signature ** Please read compliance statement on back of permit
5-3
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
111 /1. l`? /l . /`
0
Signature a14
¢f
01A !4 Vim, ! ✓
Issuing Date � Expiration Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Do n a i e-q-WeS lei ct u l n r"
Address of Property: Z,-, f -,-/ /9 , __ /3 i ///"f s (77t Ales lI
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. Ass,. 6 �- G , ��, r:a
dsenption�ar�drawrng withd'imensions must4be.piouGded.with' his Ieter,.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808 No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
RECEIVED
I do not wish to waive the 15 setback requirement.
Nnv 0 6 2017
(Property Owner Formation)
`r St�fatufe
Print or Type Name
Mailing Address
A1fw0c,r1, ff C. 2Xs70
Cityisatezip '
1-5--2 3 yi 3 k Sc,
Telephone Number
7, 3 1 / ?
(Adjacent Pro pgrJy f %jV0G4ZoYi)
Signature
Print or Type Name
Mailing Address
City/State2ip
Telephone Number
Date Date
Revised 611812012

11/20/2017
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