Scott, Linwood

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❑CAMA / ❑ DREDGE & FILL Na 70489
GENERAL PERMIT A B C D
Previous permit #
ONew ❑Modification ❑Complete Reissue ❑Partial Reisstal' 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 oncern pursuant to 15A NCAC
Applicant Name
Rules attached.
i i d Project Location: County
Address, � �'' '`4 �` _ —
' Street Address/ State Road/ Lot #(s)
City !'I % `j State Z — -- -1
Phone #!Mail Subdivision
Authorized Agent I City _ZIP
❑ ES ❑ PTs Phone # -j..� —f if fiver Basin
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AEC(s): ❑ Oi3A ElHHF IH ❑ UBA ❑ N/A --
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ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOfflcer's Printed Nme
Signature
/ r/ x j 1,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 E3asin 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 complywith 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)
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)
http://I)ortal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent 'to _lit ► /c-d
s
�` (Name of Property Owner)
ry, property located at M'
/� (Address, Lot, Block, Road, etc.
• , on o , in A S8 , N.C.
(Waterbody) J (City/Town and/or County)
r 1 The applicant has described
to me, as shown below, the development proposed at the above
location.
,i I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
.Dp p1�,
le 6 �,p l
,xK
Wig
WAIVE SECTION ��C��ti
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, li%-,or groin FQ
must be set back a minimum distance of 15' from my area of riparian access unJJff�s uff�li4ici by
me. (If you sh to waive the setback, you must initial the appropriate blank belo�lll����
41 I8
I do wish to waive the 15' setback requirement. yOC,
I do not wish to waive the 15' setback requirement.
(Prope Owner Information) (Adjacent Prop n Information)
,ar
Signat r Signature
e cod F<P is
Print or Type Name Print or Type
/Nyam
Mailing Address Mailin ddre
42
City/State/Zip ' Ci y/ tag/Zip
Telephone N(uymber/email address le horn/ umber/ mail addres
Date Date
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ �, L ; 6 vJD©ct SCd-ft—
s
property located at % 6q � � 0. (Name or r-roperty owner)
f (Address, Lot, Block, Road, etc.)
on cc�.gr S a� , in ��bP � cu-�ere.(AX 2S'59 y , 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 rill in description below or attach a site drawing)
'Do
MAY 2 r 2U18
-4f
WAIVERIECTLN
��l 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.
(prop e Owner Information) (Adjacent Property Owner Information)
Signature Signature*
r! / i c 2 c 41 //i? GUQlG7 SO�
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Print or Type Name Print or Type (Var�e IJ
7 75'7 �SCar �a : rb.7 %1 i._.1_� C-1-
Mailing Address Mail' Addr
Luca- cr N C . ? � gS`/ wnt
City/StatwZip City/Stat /Zip
_ asa- 99- 11ys1 .s - 393-75173
Telephone Number / email address Telephone Number / email address
Date _— 4 - _ OO - l(Z
Date*
*Valid for one calendar year after signature" (Revised Aug. 2014)