Tippett, Kim

[I CAMA / 7 DREDGE & FILL A B C D
GENERAL PERMIT Previous permit #
I —'New -'Modification ; I.Complete Reissue DPartial Reissue 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 15A NCAC
[�Q Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/,L-6t #(s)
City State ZIP
Phone # E-Mail Subdivision
Authorized Agent City— ZIP
s CW D-EW TA EJ ES E PTS Phone# River Basin
Affected �01
AEC(s): D OEA 0 HHF El UBA El N/A Adj. Wtr. Body _-Anat /man /unkn)
El PWS:
Closest Maj. Wtr. Body— -
ORW: yes/ no, PNA yes P,&
arm
M9
MEN
cubic yards
Boat ramp
Boathouse/ Boatlift
t-JIF
9
Beach Bulldozin
Other
T
0
— — — — - — — — — —
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes .... ........
Photos: yes
Waiver Attached: yes " no
A building permit may be required by: ❑See note on back regarding River Basin rules.
Note Local Planning jurisdiction)
Notes/ Special Conditions V
Agent or Applicant Printed Nape
Signature ** Please read compliance statement on back of permit
Application Fee(s)
Check #
... -_ ­�- I !
Permit Officer's Printed Name
Signature
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
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

03/20/2016
l

DE & FILL
C;
y k':% A B D
p ��E PERMIT
Previous permit #--
L ❑Complete Reissue ❑Partial Reissue
• Date previous permit issued ,#
odificabon
Nev✓
of North Carolina, Department of Environment and
Natural Resources
e r
the State
Resources Commission in an area of environmental concern pursue to 15A NCAC
l .
As author11ed by Rules attached.
e Coastal , i✓� • i
and the f 4
I�rQieci Location: County 1 'i ¢" ""�•
j
Applicant Name "T -
Street Address/ State Road/ Lot #(s)
,u�
s'
A -
ddres :Ir ' State t IP 4'
City_- — -�.
r ,
Subdivision
Phone # (A) "�,,,' E-Mail
ZIP
City fir',". -
o..,-�"
Authorized Agent �� s
`N�W C� EW [ i PTA ❑ ES ❑ PTS
q
Phone # (_) River Basin j1UL�
''
Affected ❑ oEA ❑ HHF ❑ IH ❑ USA O N/A
° ' c "+..• nat man unkn
Adj. Wtr. Body '. '
AEC(s): ❑ PWSy
PNAes / no
Closest Maj. Wtr. Body
ORW: yes/
Type of Project/ Activity ;v
i�s
(Scale: ` )
Pier (dock) length
Fixed Platform(s) ■■■i■■■■■■■■[1■■■■i�■I■■■■■w■■Dribl
Floating Platform(s
Finger pier(s)
i i ■■■■■till■■■■w�1a�■■■!■■■■�!■l�■'■■i
Groin length
number
Bulkhead/ Riprap length Eno A
■L ■■ a J■■■t1■■■■■■■■■■■■■■I
ayg distance offshore■■■wwnrww�■���Ew■■IFIwBasin, channel �e���■■■
max distance offshore— main, ROU on
■■■ww■w■ww7�w■w■r■■jjil■■U■■■�
■■■■■■■www�ww■■� w■w■■■■i■■r�
cubic ■■■■■■■wWwBoat ■w■ww■■■■■■■■■wwl� u
. ■■NE
■■■■■��■■■■■tI■L1C!■■■■■■■■�"r■■��i
Moor
Boathouse/ Boadift
SEEN mmaimiailiiitv
Beach Bulldozing --- . w■-------
■■■■■-- --
Shoreline Length ..-
SAV: not sure yes f no .
Moratorium: n/a yes
Photos: yes :nd
%
4
Waiver Attached: yes {ib' ` 't,
?id.-`
❑See back regarding
A building permit may be required by: liii �-
<•• ' note
on
( Note Local Planning Jurisdicti )
i 1
R
f
tt
Notes/ Special Conditions d
3
'yam �Oi
wL
Agent or plicant Prirrte N e
Permit Officers Pri led Name
Signature read compliAce tatement on back of permit"
Signature
(`}please
. ,. � � r•�,,,.� �
Issuirip Date
__ Expiration
®E
sw

WAIVER SECTION
i and (stared that a bier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
ba^clt a rninimurn distance of 15' from my area of riparian access unless waived by me. (if you
wish to -waive she setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement,
I do inot dish to waive the 15' setback requirement.
{Prc► eriy" l_nfcxmatilon) (Adjacent Property owner Information)
s Si azure
3 �P nt or TypeName��
Mailing Address
A&AAQ 6=4t /fit Z&5'5 7
CiIStafatip
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Scanned by CamScanner

p 'ih8 acppttcant nas a?BSC(tp�J3 to me, .as, .sh-p- below,`ft.devoloprnent proposed.atthe•'above.
-- y [-have no oijeciien #a.this".proposl:.
l have"objecinns #oils proposal
D�SCR[PTIOL I[ EXR QF�[Itff #j kftOP(S
(lna(iy dcial proposiefow or &Adh-a•s to drawing] = �'
A�.
jr
� _
WMV ER soonon.:...
l undersiand t�i t: a !?fir► ► [>Toorm : j ri s2 reai wafer, bosthouse; lift, or groin mus# be set
bacK a rani[rfum.dim_'ride o f"5,fam iiaaf:ripriari:accss uNess waived by me. Of you
wish #o -wavee .the aeack; you must traiaf #h. appro riate bianlE below.)
_. :
RECEIV
t-���
( do wish-to_viraive.tFe 15'.seaek requirement_.
i do -not ih' M to waive tine 15' setback--requlreme'nt . �{
�PrQperty 7Owr#fd �oo}. : tacent ir> oMation CITY-
ka
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i r7 a PrInt:w' - ype-Narne
roll .
Telep um 7reiepfione�lliiiber
Dati , •Y
(Revised 6/1812M) "
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