Walker, Thomas & Anne

AMA El DREDGE & FILL 71307 A B C D
ENERAL PERMIT Previous permit #
New Modification ication -:Complete Reissue Partial Reissue Date previous permit issued
Asauthorized by the State of North Carolina, Department V Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached.
Applicant
Project Location: County
Name
Address
City S ZIP
I Y
Phone # (_ _�- -Mail
Authorized Agent
Cw AEW XPTA F1 ES 11 PTS
Affected
OEA El HHF 0 USA F, N/A
AEC(s):
Pws:
1A1 PWA vac / no
I Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Piatform(s)
Finger pier(s)__
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
-
Basin, channel
cubic yards
Boat ramp
Boathouse/ Bo lift
Beach
Other
Street Address/ State Road/ Lot #(s)
Subdivision
ZIP
City ZIP
Oer Basin
Phone # C
Adj. Wtr. Body_-- (nat /man Junkn
Closest Maj. Wtr. Body - --
0
(Scale: i __ )
Shoreline Length
SAV: not sure yes n
Moratorium: n/a yes
TT
Photos: yes i i
Waiver Attached: yes
A building permit may be required by: Ju 14L11 See note on back regarding River Basin rules.
Note Local Planning jurisdiction)
Notes/ Special Conditions A
vn it
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
i J
PermitOffic( r's Printed Na
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/ 1-888ARCOAST
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)
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 adjacer►t to �ory Lb t'E t1132`^ n-4r 's
(Name of Property Owner)
property located at 72 ia± Q r-4. —
Address, Lot, Block,/Road, etc.)
on_ Q U? 0 ur,d , in , N.C.
(Water ody) (City own 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)
t 17S 7�ru C— G �'
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.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop rty Owner Information) (Adjacent Property O ner Information)
Sign a Signatur
Print or Tye am Print or Tem�ppee Na r
r ��y fi'/,�►,, e f hAty
rngr Add ss A Marli �AcfdSe I C ��j 1�
r
City/S a e2r City tate Zip
'W-X2Ym %V, 23 -g.2-/-o`��
Telephone Number/email address Telephone Number/email address
Date Date*
*Valid for one calendar year after signature`
(Revised Aug. 2014) Itl
tioc�
I,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to. _ r hor"as t A nag l is 4r- s
property located at / Q (Name of Property Owner)
S , .
L in rtid
Address, Lot, Block, oad, etc.)
on u ` , in , N.C.
(Water ody) (City own 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)
erJ
� d
Poo
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.
(Pro rty Owner Information)
T
Signature
T/ s'b' � /��
Print o� e M-A
ing A d ss
r .
City/S a e&!
,;s1-229- %IZ3
Telephone Number/email address
s /i.-iC,
Date
*Valid for one calendar year after signature*
(Adjacent Pfogfegty Owner Information)
Telephone Number/email address
Dare* O IV- "Flo
(Revised (Revised Aug.

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