Gardner, Kris

c s�. Q► / ❑ DREDGE & FILL NO. 73946 A B CC. 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 15A NCAC ,Rules attached.
Applicant Name_ -__ - Project Location: County_ / { -r /'- - - -
Address Street Address/ State Road/ Lot #(s)
- - - —
Ci
tY State ZIP _
Phone # (_ )_ - E-Mail Subdivision- - - -_ -
Authorized Agent ZIP
City -- - - +
ElCW ❑ EW El PTA - ES PTS Phone # (— ) _ —
River Basin
Affected OEA ❑ HHF IH `1 UBA N/A j
AEC(s): ❑ ElAdj. Wtr. Body _ l ; a � 1 c
❑ PWS: �
Closest Maj. Wtr. Body
Project/ Activity
Type of
(Scale:
f
f
)
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
cubic yards
i
I
_
t
I
r
{
Boat ramp
Boathouse/ Boatlift
I
1
i
1
Beach Bulldozing t I
Other
Shoreline Length
SAV: not sure yes no
i fi' I
IMoratorium: n/a yes no
Photos: yes no_
Waiver Attached: yes no -f
-
A building permit may be required by: [See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOfficer's Printed Name
Signature
Issuing Date Lipira4tioDate

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/ 1-888ARCOAST
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

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 3*— 9-4 g
Name of Property Owner Applying for Permit:
A`
/" j ,C9 / A h N-e lam'
Mailing Address:
po ox I I s I
Rkt,E1Utk( NG 0
I certify that I have authorized (agent) L4us reA--Xto act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
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This certification is valid thru (date)
3 .R.0
Property Owner Signature Date
RECEIVED
MAR 13 2019
DCM-MHD CITY

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