Sumrell, Joe

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❑LAMA /❑ DREDGE & FILL 2 71320 A B (%—(� D
GENERAL PERMIT Previous permit #
'E New "!❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality -7t7 6,0
and the Coastal Resources Commission in an area of env otmental concern pursuant to I SA NCAC
El Rules attached.
Applicant Name Ji tr Project Location: County
Address �^t ��` ' Street Address/ State Road/ L t #(s)
� tote f". � ZIP
City � y Stat
Phone # (: t) E-Mail Subdivision
Authorized Agent
Affected ❑ CW 0, W [?l% A ❑ ES ❑ PTS
AEC(s): ❑ OEA ElHHF ElIH ❑ UBA ElN/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach
Other
City r'►""y ; . „ - .� -- ZIPI`
Phone # O River Basin
Adj. Wtr. Body , ` x na man unkn
Closest Maj. Wtr. Body
saw
owl
BENIN
MM
■■��W1■■■�
(Scale:_ )
A building permit may be required by: +f - ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions "44
Agent or Applicant Printed Name PermitOffi r
Si t e Please read compliance statement on back of permit Signature
r r ,3
ApplicationFee(s)f Check# I55uirlgDate
xoirat n 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
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
13 I hereby certify that I own property adjacent to VDE C �a-��� r�1 4z-z - s
(� me of Property Owner)
property located at O 0 U /V D T#w
m1 01, Le
(Address, Lot, B ock, Road, etc.).
on A/`C�o1Jf A D 11J0 , in ism &Ah L p iS N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locaWrx
'(f 0)1 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)
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f
a° �r C- R om✓ SCE p 1,/ JIcE� 1 ,.,1G .
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RECEIVED
MAY 21 2018
DCM-MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
(P, opeLty Owner Inform at" n)
e-S
ignature 4,4ffot m 5 u." )f e4l.
.Job C , A'zieni?t-LL
Print or Type Name
_'82o (, 5 U u.YuD
Mailing Address
CitV/State0p
Telephone Nu%%��ber VS
Date
(Adjacent Property Owner Information)
Signa re
P-LAY-it)N
Print or ype Name
Mailing Address
�-
City/Stafe/Zip `
Telephone Number
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to d 0 G-/ (. , e � a-lfca /7), _Sr)r"/{E-.,C's
(Name of Property Owner)
property located at D 00"',0 L21, I-Ins1<i9 L1, 1,641- Al (- :XVS-15/
(Address, Lot, Block, Road, etc.)
on d orou L Svj)�jO in LD /ALA , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
qj J� S 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)
�X
�GCrL�SS Uv? �¢T1�'t
/ d Ll AE 4�"T AWe-eLk tJ� C 4 ,z/
RECENED
MAY 212018
DCWMHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
�(Propernt Owner Infor ation)
(A ent Pro Ownerformation)
tgnature �-J9 ,4uE
L t
Si turn }� \
1 b
�d4- C, .<U,R0-
�L C
0
Print or Type Name
Print or Type Name
M7fling Address
77 I-Cx 9 L/J
/,.S L-L, J✓L S-
Mail' Address
P v 1 e-v-VA- (J
rritv/State/Zi
15- �
�� $�
City/State/Zip
5.�2- - q 4
Telephone Number
Telephone Number
O S 2 "le
Date
Date
(Revised 611812012)