City of New Bern C/o Foster Hughes

Al
CAMA / ❑ DREDGE & FILL
N2 71329 ! C D
GENERAL PERMIT
A B
Previous permit #
❑New EModification El 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 15A NCAC
ElRules attached.
Applicant Name < ; ; : ,
Project Location: County
/
Address
Street Address/ State Road/ Lot #(s)
''�c'.
City 1 t`� C �4,A,1 '' € t j`1 StateJZIP
�('F
Phone # (€ - ' E-Mail
Subdivision
Authorized Age/n"t
City , ZIP
❑ CW ElEW ElPTA L7 PTS
Phone # ( ) River Basin
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body ' ' ! l ! ' f - nat man /unkn)
❑ PWS:
�i
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / Qno-�
Type of Project/ Activity
(Scale: r )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger piers) J
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore /
Basin, channel
cubic yards
Boat ramp t
Boathouse/ Boatlift _
i
Beach Bulldozing Ij
Other
Shoreline Length / t i
SAV: not sure yes no
Moratorium: n/a yes no
._ .....
Photos: yes no
a � -
Waiver Attached: yes no `
A building permit may be required by: % . ( ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) i
Notes/ Special Conditions
Agent or Applicant Printed Name j
Signature Please read compliance statement on back of permit ,
Application Fee(s) Check #
r
PermitOfficer's Printed N�rpe
{
Signytuye
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/ 1-888-4RCOAST
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to U I\ { 's
/A� ame of Property Owner)
property located at V 1 / —_--
r� (Address, Lot, Block, Road, etc.)
lIC on Q,e R ►yis, ,in K\ l./J B�A it.1 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 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 sib drawing)
rc4,?- Od on it,, s�ILPJI Wu o -f
"Pck-ot ko s- c b ri I Zit
�.ru S i olk
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lik 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.
L, I do not wish to waive the 15' setback requirement.
(PZeZOWFMF 1 tion)
Signature
t or T pe Nerw
c� T� n x I
Mafifng Aimee y-ri— a�
k�1e �J -�1�'jj
OwstawUp
T ne Number
Data
(Adjacent Property Owner Information)
Ate,
Si' L '_ ,
. 5 afore �
Prinf or Type Name
_ bDYKI
f►,� address
Cfty/statelzip -�
Telephone Number
Dare
(Revised 811812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to C I T Nt W Bern' is
property located at 10 C A V f, n iu, A(Name of Property Owner)
(Address, Lot, lock, Road. etc.)
on !use ( 1 V _, in -- N �_ W �.kg n , N.C.
(Wa rbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
A,JJ1n9 VIF>I�p Alov,�+he S�qoU/lirtt o-f
1� or�1 ►� ck-YLA p-eve4 f U'A-+ h e - t vo s t t51-1t. .
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 wa' •e 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.
>perty O nor Informath
!ature
or J Nam
M,a'il^in,g� A� ass
Ci/Statel�z�'� _
Telephone Numb r O U
_7-1- I('-I�
Date
as
Print or Type Name
-? o fJO1C lIacl
Mailing Address
City/StatelZi
sa--s (-t-�(l15
Telephone Nun
Per
-i�-i
Date
Information)
(Revised 611812012)