Jezek, Whitney

CAMA / - DREDGE & FILL NO. 73206
GENERAL PERMIT A B F D
Previous permit #
[:ylew Modification [-]Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ­7 L/i
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC r7 0
Applicant Name
I ules attached.
'�`� ,, �° j '�`._'
_ Project Location: County 0 .% r�
Address
Street Address/ State ad/ Lot,(s)
City y' l' State A/C ZIP � `�� � � � �
Phone # �/
O-- � E-Mail Subdivision
V.
Authorized Agent City W ZIP
Affected ❑ CW DgVV C*TA , '�❑ ES ElPTS Phone # ( ) %jer Basin
AEC(s): 1-1OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
ElPWS: Adj. Wtr. Body �' `4 man unkn
ORW: yes / no PNA yes LnyClosest Maj. Wtr. Body e` V
f
Agent or li t Printed N me Perm
p
Please readcompliance statement on back of permit Sign<
ee(s) / Check # Issuir

..
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 1 _ 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/ 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)
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)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner. Alit,("'D: CIez&
Address of Property: car fir: 0yet S1 C ' 6 oyr� 1� NCB Zf� 54U %�V1 s) b iv
(Lot or Street #, Street or Road, City & County)
Applicant phone #: � t o - 3912 —(� i 3
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
aI have no objections to this proposal. I have objections to this proposal
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact—dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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)
Signature
Print orTy Name
Pw- V ewt
Mailing Address
�a ICsofl�i I(,e—
CitylState/Zip
'II0--�X�2-1813
Telephone Number
Date LS _4w, ()
(Riparian Property Owner Information)
Signature
Print or Type Name
4 )9a t'V' '� (i Lu
Mailing Address
sL�yI L ,
CitylState/Zip
Ito 3 } -231s
Telephone Number DECEIVED
Date -gyp '9'6 2018
f `V
DCM-lyi HD CITY

CERTIFIED MAIL . RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: Pew k +° iu c -Sackswu fq,� � S ��o Ln s J o ►y'
(Lot or Street #, Street or Road, City & County)
Applicant phone #: 01 ( 0 - 3b 2 - 1 �2) 13 Mailing Address: &1m Gt bey e,
(eel 1 ayw-)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if jou have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.)
WI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
V61W D. �at k-
Print or Tytfe Name
S ear V, r(A &-
Mailing Address
'Ctc(.,4 onVk No, M4-0
City/State2ip
Clio- 3,92- 1? i 3
Telephone Number
i `a- (
Date
( iparian Pro Information)
Signature
1 'Iaux'rtc 2 t v
Print or Type Name
3 0C--1 Vu00J �RKoc BY;
Mailing Address
a . z&yJ✓J1e F (\ic; 2ssQ�
City/State2ip
�flo -353-
Telephone Number RECEIVED
Date SUP 0 6 Z018
DCM-%I�i) CITY

ti
t-1
RECEIVED
--7zio 20,18
DcM
CITY