Kirkwood, Betsy

ECAMA / C DREDGE & FILL NO. 73316 OC
GENERAL PERMIT A B D
Previous permit #
7New ]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality -7 //�
and the Coastal Resources Commission in an rea environmental concern pursuant to 15A NCAC C.l
E' ules attached.
Applicant Name l"-1 ! ` i / JJJCCC , k fi Proje
ct Location: County {` .
Address_ C/ tr i Street Address/ State Road/ Lot #(s)
City_J,,e /
Phone # (?--Vl ) f "
Authorized Agent
State ZIP_
Affected ❑ CW 137FrA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW — / — own I
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) t n
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other tit
Shoreline Length 6(-.l
SAV: not sure yes
Moratorium: n/a yes
Photos: yes o
Waiver Attached: es
t r
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Subdivision
City — ZIP
Phone # ( )_ River Basin
Adj. Wtr
gna.BodY /, man /unkn)
CIACPct Mai Wtr R-4'
1
cAr� I
ca V . r •• ) A �"�•
(Scale../(f I.) )
.-
/ r - ❑ See note on back regarding River Basin rules.
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's
Signature
Issuing
i Name•..----�-+ � _
Expiration

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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

Mi/JMVCI. 1 Rlf'�1RIM1\ rRVI'CR 1 I V�YI�CR J I A I COICIr 1
I hereby certify that I own property adjacent to Dime / t �� !) �I �C tr>� 's
property located at �l1C (Name of property Owner)
on �� n �S C%ri n✓Y� (Address, Lot, Block, Road, etc.)
in Lot, Block,
I 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 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
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) (Adjagent Property Owner Information)
Signature Signature _
Print or Ty'e Name Print or Type N me
q?/q/ram�f r7lY,
Mailing Addressd�� � �g� Mailing Address /� I � L ! ( r .
wel 11 CIO 17 � i , /` � tl� 0)
City/State/Zip_ ram City/State/Zip 9I ,), C / -
�25a'yZ`i"K�i 5 / i�Gt1iP�ILrt �LiAV) ,N1cCil.c�y✓i 1 7 '
Telephone
Number/email
address Telephone Number/em I / address �t �
((�i Z� . Ifs 1i�►�3���
Dare
Date
*Valid for one calendar year after signature* (Revised Aug. 2014)
Rrr 4' "! _
r"kih111'� C V•�1I
NOV 2 6 2bid
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
r n � % �^�^
I hereby certify that I own property adjacent to t? ? �. S !, � �G �� cQj/
property located at19 ` / ! / (Name of Prope Owner)
on 12 (Address, Loot, Block, Road, etc)
in met ( 7 , N.C.
(VNaterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
focatioo.
_�_ 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)
t
Wi�►11/ER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or qroin
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.
owner intormation)
Pent or type Name
M ling A!Cdd
�rps
City/ atealp
-..z- t �i- 6 62
Telephone Number/email address
li - zL) l�
Date
M
*Valid for one calendar year after signature'
(A ja¢entProperty Owner Information)
`
Y I
Signftune
P t 4 Type Name
Marling Address
z kc
Q lStatelZI� kret-NPI-4
Telephone Number/emaila
I L-Z)e
Dale*
(Revised Aug. 2014)
RECEIVED
NOV 2 6 2018
DCM-MHD CITY

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