Stockmann, Paul

It/ 96
�IJCAIVIA / DREDGE & FILL Ny I I 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 I SA NCAC
❑Rules attached.
Project Location: County
� j "• �, (° � ,; t >� YlI ty
Applicant Name � — _
AddressCc
1 Street Address/ State Road/ Lot # s
I r
�4 ZIP . f" ; l ,"C P
City r } 5� !� State_ —
Phone # (_ ) E-Mail" Subdivision
Authorized Agent L _t(I - # City----- . ZIP____
Affected ❑ CW ❑ EW _N,PTA ❑ ES ElPTS Phone # ( ) River Basin
AEC(s): OEA HHF ElIH ❑ UBA [I N/A Adj. Wtr. Body "^ �! G+r 1(� (nat /unkn)
PWS: h, r r 'l -
ORW: yes no PNA yes / no
Closest Maj. Wtr. Body_.__ ki,ir Y N r Vim.
/
Type of Project/ Activity
(Scale:) )
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s) _
Finger pier(s)_
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore ,
Basin, channel'(
r
cubic yards
Boat ramp .r'"
Boathouse/ Boatlift
Beach Bulldozing w
Other rf
J
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes �., no'
Photos: yes j_ no
Waiver Attached:
.,,. yet' no
t .
A building permit may be required by: ETSee note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions # � Y r, ``V �—`
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check#
Permit Officer's Printed Name
Signature {
Issuing Date &Pioion 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 became
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:
L_j 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/ I-888-4RCOAST 252-946-6481
Fax: [phone] 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)
(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

I/
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
Ito YwN^A►CA
LOT NO. �EL.:T PLAN NO.
PARCEL ID: Z- O 6-7 - Ito
STREET ADDRESS: {o (00 iJQ �cC ►-1 "' uQ_ —�____
0 ---- ---
Please print:
Property Owner: oL kvvl �4l•I�)
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Eric Pake, Jr.
, of
(Contractor / Agent)
Eric Pake Jr. Construction, Inc.
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
mA01 I a 1 �.
Authorized Signature Authorized Signature
Date: yam(? c� l Date:
��=L'-INFO
JUL 13 2018
DCM-MHD CITY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to pR V L- S-rOCKw>. P-�- N1 N 's
(Name of Property Owner)
property located at (01 O 0 �e L r c w w �� -
Ai12..iieLD ,ge�3w� Address, Lot, B ock, RAad, etc.
on - �, ( MA , N.C.
(Wa erbody) (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 fill 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.
Information)
Signature
P ' t or Type fie
rq L 1` or C� M ar
Mailing Ad ess
6106 rQC(cotw n
Ilj/Qt j -2 v A
Telephone Number/email address
'L65-6g�-- S—,C)L(&
Date '>4z1/zatY--
*Valid for one calendar year after signature"
(Adjacent Property Owner Information)
Signature * '
Goo 4*-U �'� -t W vd d S
Print or Type Name
ra (aZ ���tcvrw
Mailing Acid,
City/State/Zip
Telephone Numbe7/emt addZ-tzol b
Date* IRECEIVED
Aug. 2014)
JUL 13 2018
DCM_nANO CITY

PART
i hereby certify that I own property adjacent to
property located at 6 10 D VO L k
(Address, Lot, Plock, oad, etc.)
in Li N.C.
(City/Town and/or County)
on
rbody)
I
�uL ��e� �,t��✓kJ
(4tWe of Property Owner)
The ap ' nt 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 fill 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.)
C'4 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro
Suture
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Print or Type 1 ame
610 �Q-LtCYtw
Ma Address
City/StatelLip
Telephon Numger/email address
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Date
"Valid for one calendar year after signature*
(Adjacent Property Owner Information)
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City/StatelZip
Telephon Nu ber/e ai ddress
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Hate
(Revised Aug. 2014) RECEIVED
rJUL 13 2018
Dcm-m"n CITY

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JUL 13 2018
DCM-MHD CITY