Kistler, Walter "Buzz" III

704QQ
❑CAMA / ❑ DREDGE & FILL Vkj q B C D
r. GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue [-]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 Rules attached.
.4` ,�K1 Project Location: County
Applicant Namet 1d" T� iki/,if
i? R
Address Street Address/ State Road/ Lot #(s)
City State' 't ZIP 1 ' i
Subdivision t.
Phone # (� E-Mail-`-"
7
Authorized Agent ----- — City ZIP 9 _
i..f.
❑ CW [IEW [I PTA El ES ❑ PTS Phone # O ! r Basin
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A F 1
AEC(s): Adj. Wtr. Body � ( ! (nat /man /unkn)
❑ PWS: � , .`7 r
Closest Maj. Wtr. Body fT'
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dc
Fixed P
Floatini
Finger)
Groin I
ni
Bulkhe
a,
n
Basing
c
Boat r.
Boathc
Beach
Other
Shore)
SAV:
Morat
Photo
Waive
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
(Scale: .� )
❑ See note on back regarding River Basin rules.
Apeoor Ap�plicant Printed Permi>`O�er`rinted Name
Signature ** Pleasd d compliance statement on" back of permit Signature
ApplicationFee(s) Check# Issuing' to Expiration Date u

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 PRC)PERTY QWNE11
I hereby certify that I own property o
adjacent t
,1 (Name of Property Owner)
M.
zo
The applicant has described to me, as shown below, the development proposed at the above
10 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must Hit in description below or attach a site drawing)
7—
T7
IL
------------------ I
rO
1 611 STuq6 W"AMR SECT N
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16from my area of riparian accim unless waived by
me.
me. (if *sh to waive the setback, you must Initial the appropriate blank below.)
I do wish to waive the IS setback requirement.
I do not wish to waive the IS' setback requirement
owner Information)
'?La;!r!&t4 TO IhKrl
Print or Typb Name
ao-3 6-x-t,-nG&0
C Mefling Address
M 0 A, J 0 M t Cd a 14 (t
ac-5-'P afY/qt'@te'9P:
Telephone Number email address
t-119-1 I q
Date* '
(Revised Aug. 2014)
*Valid for one calendar year after signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Name of Property Owner)
property located at
Address, Biock, Read, etc) �- i
on �e I �e) t t F �' � , in C C-' � � ( , N.C.
(Waterbody) (CitylTown and/or Co ty)
The applicant has described to me, as shown below, the development proposed at the above
loca ,ion.
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)
� Y 161Ji,mayA '--- 151 t (q
Z. 0,57
NJ
611E IP16 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.)
x 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Ptapt,.,or Ty Name
�
Mailing Adl�
City/Stafe/Zi
t7A�9�
Tel phone Number/email address
Ad:, r, �r
Date
*Valid for one calendar year after signature*
Owner Information)
I
Print or Typ6 Name
Mailing Address �r 7
11A0 A, .i tl ftl o C�� �1 , i� �rS S
City/State/Z* �.
�5�� '��(,, 0 , o
Telephone Number/email address k/ h C�
Date*
(Revised Aug. 2014)
0

I hereby certify that I own property adjacent
/� (Name of Property Owner)
property located at at '� E' G I K) �/ )e
Address, Lo Block, Foad, et .)
on Pe,l��� 1 E' CCU -,in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to a on.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must Hit in description below or attach a site drawing)
1
l� � -- -
�!tSi►t�
Sit 1;..�. t►,,�'�
Nei 1 \ �j1tSi IPJ�, 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.)
I do wish to waive the 15' setback requirement.
i do not wish to waive the 15' setback requirement.
(Property Owner Info ion)
Sign�tu l
Ppt�t or Typ Name
g Addre k�N C
/state p
�'26 q�3
Teleahone,Number/ email address
Dat
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Sture*
Print or Type Name
?0 7 .I 1 I -I
Mailing Addre
City/�,(ate�p
ti C?
Telephone Number / email address
_
Dates
rI
(Revised Aug. 2014)