Harker, Lorraine

S-rillA / 'D DREDGE & FILL No. 73120 A B C D
GENERAL 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 an area of environmental concern pursuant to 15A NCAC
,% ElRuI s attacheg-
4plicant Name t/Or/C h e -le- '�' Project Location: County ( C✓ �"t
Address a Street Address/ State Road/ Lot #(s)
City M- _ State �� ZIP f1 C • f
Phone # () �- % E-Mail Subdivision
ZIP
Authorized Agent City f�
❑ CW'rA El ES ❑ PTS Phone # ( ) River Bal7Ft0C�at;YKa-n*Vunkn
"� f
AEC Affected
d ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A j y O Ad Wtr. Bod ✓-t G `"�`' '
❑ PWS:
Closest Maj. Wtr. Body —
ry t'''�
ORW: yes / no PNA yes � no
Type
Type of Project/ Activity
Pier (dock) length
Fixed Platforms)
Floating Platforms)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards / i l _ 6/
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
,.rCC,1,-o Z�
Shoreline Length
SAV: not sure yes no —.--- - _. _.. -- -
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: C e
( Note Local Planning jurisdiction)
Notes/ Special Conditions l c-�' X � 4 :IP
L-br rG\ ne, �Ao'r
or Applicant Printed Name
(Scale: )
❑ See note on back regarding River Basin rules.
Signature ** Please read compliance statemen n b ck of permit Signature 1
l I
Application Fee(s) Check #

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/ 1-888ARCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(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: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
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

*
I
ADJA( ENT RIPARIAN PROPERTY OWNER STATEMENT
\ `\
| hereby certify that Imw,
(Name,of Property Owner)
property located at
(Address, Lot, Block,'Road, etc.)
(Watarbw |y) (Citv[7ownmtid/mrCounty)
The appU geoor ued tome, an shown below thedeve|o0ment proposed atthe above
|o i
i^'__ | have no 'bjactmn!othis proposal,
| have obli obonmtothis proposal
DESCR(PT|/'N AND/OR DRAWING OFPROPOSED DEVELOPMENT
(Individual proposing uwelopvnentmust fill /ndescription be/ou/mrattach asite drawing)
}
/
/ |
�
WAIVER SECTION
} understand that o pmr, look. mooring pilings breakwater bnmtNouse lift or groin must be set
back a minimum diatam of 15' from my area of riparian access unless waived by me (|fyou
wish |owaive the setbac youmust initial the appropriate blarl,below. >
|dowish !o waivethe 15'setback requirement
|donot mx�i towaive the 15'setback requirement_ `
SJ
Print or Type Name
prin t or Type t,;ame
Mailing Address
/
Telephone\�
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ADJACENT
I hereby certify that I own property adjacent to
property located at
on
(Waterbody)
dAddresn
Y OWNER STATEMENT
(Narpe of Property w e
Blo>Fj7'etc.) y C
(Cityftown and/or County)
's
N.C.
The applica as 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. L IV I n � �� / i� 0 p '7, JdV
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
I 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 th ttack, 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.
qf pperty Owner Inf mation)
ti
Sig ature
Prin r Type Name ,.� LED 0
Ma �lr g Address
City/State/Zi=- 3 Ca5 j C1 U
Teleph �lNu p'rr
131
Date
(Adjacent Pro
Sin u • `
g �s G��Gry
Print ozl,ype Nar q
B -�
MailingAdoss
City/Stat
Telephone Nu ber
%�-��
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I�hereby certify that I own property adjacent to LCF`c`ca\ n C 0(3'y-Y-Q_L'
property
on
!Z6"( s �: r-J ti4N
(Waterbody)
(City/Town
County)
's
The applica s described to me, as shown below, the development proposed at the above
loca ion
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)
)c� y
/" d C vj"_ //171-W
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.
(P o^erty Owner I formation)
Si ature 1rr v
�:
fJ��r,,k 01Y_
Print or Type Name
M fling Address
City/State/Zi
_ L w as SQU}
Tele one Number
� 73 Ig
Date
iflrpnf Property Owner Information)
Signature V
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Revised 611812012)

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