62241_Mooring Piling_20181018

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CA
MA / DREDGE & FILL
GENERAL
No' / O6 T A B' , C D
GENERAL PERMIT Previous permit#^4�33�'j1• '; k
New ❑Modification ❑Complete Reissue, ❑Partial Reissue Date
•previous permit issued I,� �tV(::�D'17
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 15A NCAC
;y� ! ul-e1s attached'. '
Applicant Name /� �� �yS EPf I �L Project Location: County (,��5 NI �N C nu n1►
Address 1571 F F toI P, -Sc V)DO t 21) Street Address/ State Road/ Lot-#(s) ►Kl /1LEEM A9LE
City. 62`C14VILLE StateZIP2 3(_9FAc1.1 PAD SP_A' U93 =
Phone # ( ) �i �� -3�(3 E-Mail Subdivision /-fit [ rJNZ(F ? FA C
F�
Authorized Agent City �� ICE ZIP � 7 /a
7
Affected ❑ ew XEW- TA ❑ES ❑ PTS Phone # River Basin ©T/
-AEC(s): , ❑ OEA ❑ HHF 01H ❑ UBA ❑ N/A Adj. Wtr. Body �L 9C MA r SOV 11)
}} c hat man unkn ' ❑ PWS
ORW yes / no PNA -yes / no Closest Maj. Wtr. Body l- CMA9,K - SOOND-
Type of Project/ Activity A-1A'Mni-eEy, It4pp�Ir1G �r'CII�%� v
a• =(Scale: ) it 3 7� ,r
Pier
Fixei
Flom
Fingi
Groi
Bulk
Basil
I , Boat
Boat
Beac
M~ Shor
i` SAV
Moe
Phoi
Wai,
WIN
■■■■
"■
■i
■■■■
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u
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�■''
iead/_-R,iprap length
- avg distance offshore
max distance offshore
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■■■■■■■■■■■■■■■■■■■■■r■■■■■■■■■■■■■■■■■
.■■cubic
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yards
ramp
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smell■■■.■■■■■■■■■■■■■
■■■■■■■■■■
■■■■■■■■■■r�■i■■■�■■■®■■■■■e■
-line Length
'not .■■■■■■■�■■■■■■■■■�■■■W■■■
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su yes
torium: n/a yes 7no— •
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.
A building permit maybe required by: WAs4 6-m-m co UN i ❑ See note on back:regarding River Basin rules:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions 2200 CoN p1'(1ed). I� ltl2 1�LRIro(M 1 QatT Hwft J1 I5V 1 t 1+ I
1� 3t,tc 9oi� CG�33R•ts� - ,. - -� .. ..
t or Applicant Printed Name
ignature Please read compliance statement on back of permit
d.o
Application Fee(s) Check #
Permit Officer' Printed N me
Signature
Issuing Date „- Expiration Date -, '

.. •_-_.. .: ��.s,.���� '��'` Esc:..-_._'ci.f t:rsyr��, _�_._'�'C;�._c'r� �..-.-,_._ _ -_ �t:'�-�'� ,.o='`B.`;-�''?
Applicant: Ddl) A
Date: l p c,T Lo 1�
-General Permit M
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
im act amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
A
Dredge ❑ R16—Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill-❑ Both ❑ Other ❑
:.-_ .�-;w:�_�-_. � �. .���,4'�-'�c-_,�:_. ",C-•-t' :,, i4`y� ;e; _-:�'r- i.p:i __ !�.F:G.�'.`�� h�.f�ii�

ADJACENT PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Joseph and Linda Teel's (Name of Property Owner)
property located at 1051 Albemarle Beach Road (Address, Lot, Block, Road, etc.) on Albemarle Sound, in
Roper/Washington County. N.C. (Waterbody) (City/Town and/or County) The applicant has described to
me the desire to install a Mooring Piling proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
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 approp . e blank below.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Joseph and Linda Tee
Signature
Jo5-eth
Print or Type Name L n�� lIA . f •e_ •eT
Mailing Address 1051 Albemarle Beach Road
City/State/Zip Roper, NC 27970
Telephone Number 252-714-3431
AA (Ck e �b
Signature
Print or Type Name I C qA a- (/SJ H QR
Mailing Address .1©;! ALg)OA IAdeCr T�CA(k
City/State/Zip_ROFIZe , Iv C 27 -16, Z
Telephone Number Z 15-Z - Z./ 7 - 3 Wr
Date Date

ADJACENT PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Joseph and Linda Teel's (Name of Property Owner)
property located at 1051 Albemarle Beach Road (Address, Lot, Block, Road, etc.) on Albemarle Sound, in
Roper/Washington County. N.C. (Waterbody) (City/Town and/or County) The applicant has described to
e the desire to install a Mooring Piling proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
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 -
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) (Adjacent Property Owner Information)
N CIN, ..
Joseoh and Linda T e
Signatur - Sign
t1syk
OPrint or Type NamecJrA ( Print or Type Name
Mailing Address 1051 Albemarle Beach Road Mailing Address
City/State/Zip Roper, NC 27970 City/State/Zip
Telephone Number 252-714-3431 Telephone Numbe
Date ( Date