Rouse Brothers LLC

QCAMA / ❑DREDGE &FILL
N271684 A B C D
GENERAL PERMIT Previous permit #
FAN ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ew
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.
Project Location: County
Applicant Name`
Address" �Street Address/ State Road/ Lot
City_._ StateZIP J" —. --
Phone # �) 't f / eE-Mail} Subdivision -- —
Authorized Agent tji "{ City_°'"t�" ZIP__._-----
ElCW pfW' A pTA DES ❑ PTS Phone# ( ) River Basin
(
Affected OEA ElHHF ElIH ❑ UBA ❑ N/A nat /man /unkn)
AEC(s): Adj. Wtr. Body_
❑ PWS:
Closest Maj. Wtr. Body
_ _... I _ _ owe A .,ems / —
Agent or Applicant Printed Name
s
Signature *4 Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer'sPrintgd.Name f
Signature /
Issuin Date Expiration ate

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:
u 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/ 1-888-4RCOAST
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

OJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to a L- - L • C -s
_ (Name of Property Owner}
property located at �2� `� i� (_,y'r � � s`
(Address, Lot, Block, Road, etc.)
on i t�J in �-�i J t ty N-C.
(Wgterbody) (Cityliown 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.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
Ondlvidual proposing development mast fill in description below or attach a site drawinq)
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,
SProperty Owner Information)
(Adjacent Property Owner information)
i" �/,�/,1
r q
�X/L�
ure"
Signature
t�v
Print or Name
Print or Type Name
-'i1r7 `mot
�'t4'tCGW 1�!#i7•
i ir.E
M lira A�Ss
Ex-- 1 1\G• G 275�3i�4Lit
Mailing Address
sty rc �.C. �:$5'T
cityl latgop/�•7 _ _ _
/Stat Cl
Tal pttorre / email address
`Telepho!fe Number / email address
(((y
�%f �� -
Date
Dzar�l�
(Reviser! Aug- 2014)
'Valid fbr are calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L- � L . C • 's
(Name of Property Owner)
property located at `� �`7 �7 , t ~ �.1/1/l `� f .
` C (Address, Lot, Block, Road, etc.)
in s11 �`� 0xDL>_c) , N.C.
(Wakwbody) (City/Town arxllbr County)
The applicant has described to me, as shown below, the development proposed at the above
loa*ion.
I have no objection to this propoW.
1 have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(lnCNVk W wgxW i9 developmwt ~ fill In dsscdpdm below or attach a aft draw*nW
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
1P%petty Owner Information) djace t Pr
Tele as ber/email address
�!L
fele h nne mb�er/ email address
/Jule• � _ r
.ay
"Valid for one calendar year after (itevised Aug. 2014)
y signature'

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GoMaps
August 17, 2018 1:1,128
0 0.0075 0.015 0.03 mi
0.015 0.03 0.06 km
2018