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N,CAMA / ❑ DREDGE-& FILL No 71337 A B C D
GENERAL PERMIT Previous permit#
DNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality . --7 / I , t . r
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC f
(] Rules attached. ^ �
Applicant Name
Address it) 1
City State r-= ZIP , ' c
Phone # ( )_
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
' 't-Mail
❑ EW _ ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
PNA yes / no
Agent or Applicant Pri ed ame
ZZ&
Signat re Please read compliance stafement
on back of permit`
—/
Application Fee(s)
Check #
Project Location: County I
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin AW
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Permit Officer's Printed Name, r'
Signatu e h
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, certifythatthis 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
More ead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-411COAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(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:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
Revised 7/06/17
I hereby certift
V\; L
I own property adjacent to'�%�%L=" s
N f P rt 0 ner)
n� ( ame o ropey w
property located at " 1/ I
(Address, Lot, lock, Road, etc.
on E�� It �/ , in V'A-ti [) C--M L: R , 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 9 site drawing)
■ Complete items 'i; 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
. r nn the front if space permits__
Article Addressed to:
L-
223 tt3
I11M IIIIIIIII1VII 1111
9590 9402 3327 7227 2514 09
2. Article Number (transfer from
laben
A. Signati; re p Agent
❑ Addressee ___
B. ved by Pr*n d Name) C. Date of Delivery
D. Is delivery address different from item V
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express¢v
❑ Registered MallT.
❑ Adult Signature
Signature Restricted Delivery
p Registered Mail Restricted
❑ Adult
Certified Mails
Delivery
❑ Return Receipt for
❑ Certified Mail Restricted Delivery
❑ Collect on Delivery
Merchandise lift, or groin
❑ Signature ConfirmationT"'
❑ Collect on Delivery Restricted Delivery
13 Signature Confirmation sss waived by
rl ln,,wP.d Mail
j Mail Restricted Delivery
Restricted Delivery
7 017 2400 0001 1534 8 911 soo) Domestic Return Receipt
PS Form 3t311, July 2015 PSN 7530-02-000-9053 V lent.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
r
S.
igylurcl
Pri t or TyeNametoorr Tye
Mil rl!�7
Clty/State/Zip
Telephone Number / email address co llkf
Date
*Valid for one calendar year after signature*
(Adjacent p Owner Information)
fc� tv
Si nAture*
tI/Cn
Pri y or,Type me
Malin Add re s �1
City/State/Zip/�
Telephone Number l/emaL address
��� 3
Date
(Revised Aug. 2014)
J-D N q pF
VN-NDE-MLzAa
130 r;. AWAY
oA�l
RyvcR
--� S �
�tl��� PRLR TPPOPEAT
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Your item was delivered in or at the mailbox at 8:23 am on May 31, 2018 in VANDEMERE,
NC 28587.
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May 31, 2018 at 8:23 am
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VANDEMERE, NC 28587
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