Arthur, Bart

� CAMA / DREDGE & FILL N2 71156 A B C D
revious
GENERAL PERMIT Piermit #
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 an area of environmental concern pursuant to I SA NCAC ara� #✓y
1 ules attached.
Applicant Name _ Project Location: County`
Address sl `'� Street Address/ State Road/ Lot #(s)
City _ _. State A/ _ ZIP
Phone # ( )
Authorized Agent
CW
Affected OEA
AEC(s):
PWS:
ORW: yes / no
E-Mail
SEW 'PTA
HHF IH
PNA yes / no
Type of Project/ Activity
Pier (dock) length I I}
Fixed Platform(s) F
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp x L
Boathouset Boatlift € 1_ _f /
Beach Bulldozing
Other
Shoreline Length ` `J'` LJ
SAV: not sure yes no;
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
❑ ES F- PTS
UBA N/A
Agent or Appli nt Printed Name
y:k
S#tub: Please read compliance statement on back of permit
"J
Application Fee(s) Check #
Subdivision
City - -
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body__
ZIP
River Basin
Cnat /man_/unkn)
(Scale: )
L See note on back regarding River Basin rules.
r-x )
'C
PermitOffice s Printed Name f
Signature
J { !
Issuing Date xpirati 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 252-946-6481
Fax: [phone] 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)
(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://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

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8/14117, 6:44 PM
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preposiv dwohw om ANI1n� PROPpe�pDEVELopuleff
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I tndarUWW ttW a poor. dock. mooring pups. boat ramp, brooWel r. boathouse, YRt or pain
ns * be IN back It maamurn dattanoe of 15' "M my area Of rIPWWt at =6 t rAM warred by
me. (if you wish to waive the so beck, you must InKW the sWoprisM blink below.)
I do wish W waive the W setback requirement.
I do not wwh to wOVe the 15' setback reqAvrraft
(Properly Owner boo i otlon),-� ( owns Inlonnollan)
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17
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(Revised Aug. 2014)
about:blank Page 1 of 1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to rA at, f Pl)('► h t4 r 's
Property located at 221 �-�d—d—
S�t,B
me of rope OwnD:on Way DV%I (AresRoad, etc.
in (R,� a Ir t , N.C.
e y (Cityffown a dfor 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
(WiWdual proposing development must fill in dsscrfpdon below or ,attach a sft{e a!}awing)
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.
(Property Owner Information) ( ac rope Owner Information)
9� t/ N N C
�e .
Sr re S ature
17&y - f " /'T1/'I hM •r r
Print or T Name �1 t or Type m
It1 ✓` -t ,S�ovcs Vy J5& 115s %
Mailing Address 1 i 5 L ding Address
I 7 oe,' 3 7S
Telephone umber /�e•,mail address Telephon mbe %email address
Date nave
(Revised Aug' 2014)
'Valid for one calendar year after signature'

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