73188

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
^'New 'Modification ❑Complete Reissue ❑Partial Reissue
s' No. 73188
/1
Previous permit #
Date previous permit issued
B,C D
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
--[:]Rules attached.
Applicant Name _ Project Location: County. t y
Address r ' + �} ! Street Address/ Statf.Road/ Lot #(5)�
City_ _ _ State ZIP
Phone # () _ _ E-Mail
Authorized Agent
Affected [ICW ES El PTS
AEC(s): ❑ OEA A❑ HF ❑ I ❑ UBA [IN/A
❑ PWS:
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�/`I2iprap 11'
avg'distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bul
Other
Shoreline Length
SAV: not sure yes n
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes 6e
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signatur Please read compliance statement on back of permit
J
Applic4ti6n Fee(s) V Check #
Subdivision
City
s ZIP J.
Phone # ( ) River Basin'
/ i
Adj. Wtr. Body t. t e nat man Junkn
Closest Maj. Wtr. Body
(Scale ... )
n See note on back regarding River Basin rules.
I
ire
Permit Officer's Printed Name
Signature ry
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, 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:
J 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
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 Mail
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bettie, 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
I hereby certify that I own property adjacent to _- .Te.ndeA H e-Ca-h 's
( ame of Property Owner)
property located at I �, Wlr Am � C 3� ' RoCJ ; J z-r r17'
} n (Address, Lot, Blpc Road, etc.)
on. tino l_ree� , in �-��'!� l �.c�r4CF-� Cv, , 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; r
I have no objection to this proposal.
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)
Cjewc - +�) e I o pe-4 down. -- o -he- Loc er ;
C,ne✓
'4nd Q-p P ly cz—v +rol x C P J ea- e_ %b ee 0iff Qs�k-rne,4�t)
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.
(Property Owner Information) SAdjgcent Property Owner Information)
--c'eL,n ! 4+
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Sip nature �
K� t t
Print o Type Name
�d I n P lop
Mailing Address
Val rztt ne I/A 43F8 7
Ck /State/Zip
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Telephone Number
Date
or Type
Mai "ng Address
b r�.4:� , ��►
City/Statelzip I
Telephone Number
/ C) / >-z- ( /
Date
�v
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ "ReYAe.-k\ �. t4er'i''. is
Cy� (Naipe of Property Owner)
property located at
(Address, L,,o��t,, BIQQck, oad, etc.) t
on kQAno� `._x , in LaAer Cp.• i-eiit�, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the. development proposed at the above
location.
f� 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)
O ear.
+h
OL-Vid.�1'l
��iesn
Con-►ro�
°. �1`��ecxse Sep
c�,`c��.�►e
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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjace a
nor Inf Lion)
Signature
ignature
Print
or
,Type Name
Print or Type Name
.
0
4 !`i n e_ ro - b 1" ,
l9
M Ili g Address
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Mail' ddress
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Cit /State/Zip
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41
City/State/z
p
?S- Z 2 23
Telephone Number
Telephone Number
16 - - I n1©1 P
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Date
Date
(Revised 611812012)

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