Best, George Jr.

It/
r. • ❑LAMA / ❑ DREDGE & FILL Na 70469 A B C 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
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
fj4'Rules attached.
Applicant Name Project Location: County ! rz
AddressX. 3'c ' Street Address/ State Road/ Lot #(s)
City 3 ~ f"` t1 -- . v riState
Phone # E-Mail —
Authorized Agent
Affected ❑ Cw ❑ Ew ❑ PTA S K PTS
AEC(s): ElOEA ElHHF ElIH ❑ UBA ElN/A
❑ PWs:
ORW: yes / no PNA yes / no
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
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes rn)'
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
' '—
A building permit may be required by:t.
( Note Local Planning Jurisdiction
Notes/ Special Conditions'
Agent or Applicant Printed Name
Signature. "Please read compliance statement on back of permit
S J
Application Fee(s) Check #
Subdivision
City
ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
r r ; ! (v See note on back regarding River Basin rules.
Permit Officer's Printed Name
V Z111E
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
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888ARCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
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 7/06/ 17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
of
property located at_ c 5 / / AL(4) IC 1) (-_SbytA keJie. 1
(Address, Lot, Block, Road��1:7—
on �fi- 2 &C , in , 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 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 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.)
1 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)
uree Signature' Si
Prin or pe Name P i t Type Name �-
�f LIK slob Ui�(,,/N,,A
M i ing Address lifin A dre JJ-
City/StatelZip city/S te/Zi
� fF
Telephone Numb ef /email address Telephone Number/email address
'T -�jr"-�c� LS-Z ---�L2 J' (a -3 Z
Date Date*_„�
(Revised Aug. 2014)
*Valid for one calendar year after signature*

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is ■ Print your name and address odethe everse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
e
oon th
e front f space
Permits.
1¢¢• icleAddresse itto:
C.���iV/f' �' Gta7'1/Z• [9 (%� (� �f3(TE $/4
"'° ry as ss below:
13. Service Type
❑ Certified Mail ❑ Express Mail
17 Registered ❑ Return Recelpt for Merchandise
❑ Insured Mail ❑ C,O D
4. Restricted Delive
2• Article Number -� ry? (Extra Fee
(Trans11 fer from service labs 70 06 081, a ' ❑Yes
q-_. _._e.____ 0�-- 8486 1,UU1
PS Form 38� February 20p4
Domestic R
eturn Receipt
102595-02-M-1540

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