Adrian, David

IL -
El CAMA / 'J DREDGE & FILL N2 71338 A B C D
Gt-NERAL 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 anj area of environmental concern pursuant to 15A NCAC Rules attached.
J ' r Project Location: County
Applicant Name
Address k ` Street Address/ State Road/ Lot #(s) j + "' L' t
City State` /' ZIP
— r
Phone # (_) _ E-Mail
Subdivision
Authorized Agent City ZIP _.
❑CW DEW QPTA DES OPTS Phone # ( ) River Basin
Affected ❑ OEA ElHHF ElIH ElUBA ❑ N/A t
AEC(s): Adj. Wtr. Body "(nat /man /unkn)
❑ PWS:
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) '"
Groin length
number
Bulkhead/ Riprap length
avg distance offshore fG
max distance offshore
Basin, channel r
cubic yards ��_
3'
Boat ramp l/
Boathouse/ Boatlift
s
Beach Bulldozing f'
Other
Shoreline Length y
SAV: not sure yes Cno
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Sig ure PIte read compliance statement on back of permit
Application Fee(s) Check #
(Scale:
[YSee note on back regarding River Basin rules.
J. s
Permit Officer's Printed Name `i
Signature
y �
Issuing Date Ex tiration D to

4
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/ I-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

i
-� UNITED ST/JTES
POSTAL SERVICE
Date: June 8, 2018
David Adrian:
The following is in response to your June 8, 2018 request for delivery information on your Certified MaiITM
item number 70173380000036383866. The delivery record shows that this item was delivered on May
17, 2018 at 2:19 pm in ATLANTIC BEACH, NC 28512. The scanned image of the recipient information is
provided below.
Signature of Recipient :
Address of Recipient:
11 q Gvfl�ss �,
Thank you for selecting the Postal Service for your mailing needs.
If you require additional assistance, please contact your local Post Office or postal representative.
Sincerely,
United States Postal Service

A2UNITEDSTATES
- POSTAL SERVICE,
Date: June 8, 2018
David Adrian:
The following is in response to your June 8, 2018 request for delivery information on your Certified MaiITM
item number 70173380000036383859. The delivery record shows that this item was delivered on May 8,
2018 at 3:22 pm in ADVANCE, NC 27006. The scanned image of the recipient information is provided
below.
Signature of Recipient :
Address of Recipient:
Thank you for selecting the Postal Service for your mailing needs.
If you require additional assistance, please contact your local Post Office or postal representative.
Sincerely,
United States Postal Service