Tantown, John

DREDGE & FILL 4 Oo
CAMA / -k . 73906 A B C D
GENERAL PERMIT Previous permit #
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-]New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Envir6nmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC F', Rules attached.
Applicant N e Project Location: County
Address
Street Address/ State Road/ Lot #(S)-,
City State- ZIP
Phone # ( ) --E-Mail
Authorized Agent
Affected CW KEW NkpTA ')(ES Ll PTS
AEC(s): OEA El HHF 0 1H 0 UBA 0 N/A
PWS:
^01". — PPJA vac / non\
Subdivision
City zip
Phone# River Basin
Adj. Wtr. Body 4 gnat /man [unkn)
Closest Maj. Wtr. Body_
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Agent or Applicant Printed Na1W7-:1:, Permit Officer's Printed Name
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Signature ** Please read compliance statement on back of permit Signatu e1
Application Fee(s)
Check # Issuing 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 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-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)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/ 17

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JAN-1 l-2000 TUE 09, 27 AM NO D I V OF COASTAL MGMNT FAX NO, 2522473310 P, 02
ADJACENT RiPARLkN PROPERTY ONNER STA: EMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATNOUSE)
hereby certify that I own property adjacent to 0
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
p0ings(boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEL,OP,14EIN r:
(To be filled in by individual proposing development)
.------ --------- -------------------------------- ------- -ff- ------------ - ----_ .--------
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ignat e j
Print or 7Qpe Name
Telephone Number
Date; Z - / z)

1

JAN-11-2000 TUE 09:27 Ail NO DIV OF COASTAL WNT FAX NO, 2522473330 P, 03
ADJACENT RYPA.R kN PROPERTY OWNER STATEMENT
(FOR A PIER/MOOR.ING PILINGSIBOATLIFTIBOATNOUSE)
I hereby certify that I own property adjacent to emu." 's
;
(Nameoff /Property Owner)
property located at l ` vc� s g_ C.r t ��, � ..ry,-� p r, c—,
(Lot, Block, Road, etc.)
on��� r1�E-C__-- , in Co , N,C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings(boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I b-ad wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRYPTION AND/OR DRAWING OF PROPOSED DEVELOP.MENI :
(To be f"rlled in by individuat proposing development)
Signat re
Cl"#'eveviS
Pant or Type Name
')l`7 1L� t; 3'�C�
Telephone Number
Date,

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ADJACENT .RIPARIAN PRCt?ERTY OWNER STATEMENT
I hereby certify that I own property adjacei t to -�o_h 7 l✓4-,, �" "'� 's
(Name of Property Owner)
property located at 150 6 on 12�
1y, (Ad,, •ess, Lot, Block, Road, etc.)
on �oofl; in .Q .� �0 ' 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 fill in description t-,eiow or attach a site drawing)
,I f4A� .
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.)
(P
X I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
ion)
Signature
Print or Type Name
/ qY 60 vs.e Gz .
Marlin Address
City/Statel"Zip
3733�—
Telephone Number
�/al /5
Date
(Adjac nt Propert O ner Information)
Signature hShia
Print or Type Name
Mailing
,{4ddress
Cit tate/Zi�
Q-�- a - gas - 3'� � 3
Telephone l�(umber
3��0/�
Date
(Revised 611812012)

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I hElebY certify that C own prOper-ty adjacent to L
' �`�_ _
(NameQ Property �iwner} — � �
property f ated at ¢ , .
cl
(Lot, Riock, Road, etc.)
011 in
(Town anti/or County)
Re has described t'O nll�-, M shtiwa below, the deuelopment he is proposing at that 1 tie , d, � have no ob�octic�ns tt3 �1is proposal. I understar:d that a piertrno€�z�rt
Ofin adZf lbcath use must he 1--t back a minimum di,slxnce of fIrteen fcet (IS') frc�m my area
Of riparian access unless u-awed by nit.
SAD-= wish tO waive the setback requirement.
'AQ wish to wadve that setback reqirement.
ESCR;YI'I AINUOR DRAWING OF �OPOSED DEVELQP.Nl�,�
f I t� {Ife� in by individual proposing development) ,�n F.
r/
Pr Type Name
t�:Iephotle Number ­-.' __­_
https://mail.google.com/mail/u/0/#inbox/QgrcJHrtggFkslIdVzDzlDBWFDQjFcQvTZv?projector-1 &messagePartld=0.1 1;1

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