Purser, Davis

CAMA / DREDGE & FILL
GENERAL PERMIT
-.New _Modification ''Complete Reissue Partial Reissue
I-/ No. 73397
A
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality t -) /' /
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (,
Applicant Name
t
Address J ;J ) '0a7
City _ I-ar e a ` c; ✓L� StateAJ( ZIP
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Phone # 12)E-Mail
Authorized Agent
Affected ❑ CW Q.W' E PTW7' ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF C IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Rules at cheld. ,►
Project Location: County__ �'f ; � '"�/
Street Address/ State Road/ Lot #(s)
Subdivision
City `� :_✓ r , :3� --- ZIP
t
Phone # ( ) River Basin
Adj. Wtr. Body (nat man'/unkn)
Closest Maj. Wtr. Body
171
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Agent or Applicant Printed Name —•�
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
2<7
Permit Officer's Printed Name
Signature
Issuinj Date Expiration 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 [)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)
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOA TLIFTIBOA THOUSE)
I hereby certify that I own property adjacent to mE-lt�l- 4: P 7AW-1
(Name of Property Owner)
property located at�
(Lot, Block, Road, etc.)
N.C.
on
(Waterbody) (Town and/or County)
Applicant's phone #: q 9- f)!J 78 Mailing Address:�3
I
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
,W / LTI do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To he filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
2
City/State/Zip
it
one Number _
Signature Date
RECEIVED
5 \V�
JAN 0 7 2019
32 DCM-MHD CITY
Y_--- ___________________.._____..___
(Riparian Property Owner Information)
ate- _—
Signature
Print or Type Name
Telephone Number
Date

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_�1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOA TLIFTIBOA THOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at Ll S T L L-1 /�T
(Lot, Block, load, etc.)
on �CJS�J�sE.��Z in �(:ya►�sr;,(�1>�L--- , N.C.
(Waterboody) (Town and/or County)
Applicant's phone #: I 1 �- 2 (6- 0y /n Mailing Address: y)3 S C m i
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
_ I do not wish to waive
40"I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To lie filled in by individual proposing development)
J
00 3.2
(Information for Property Owner Applying
for Permit)
Ala � S E-1-r-I
Mailing Address
S4 )A#i S 30
City/State/Zip
I q - 218 - 0" a ------
Te1ep one Imbper q
_I
RECEIVED
JAN 0 7 2019
DCM-MHD CITY
(Riparian,Prope wrier Information)
Signature
Print or Type Name
Telephone Number
Signature Date Date