Russell, Tommy

CAMA / DREDGE & FILL ! t �o. 73913 A
GENERAL PERMIT Previous permit#
New Modification Complete Reissue --Partial keissue Date previous permit issued
B C D
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
Address - Street Address/ State Road/ Lot #(s)
City —
--
-- - --- State ZIP Phone # () E-Mail Subdivision
` n - T
Authorized Agent City i . ,', �%` t ZIP
Affected ❑ CW EW PTA ❑ ES ❑ PTS Phone # ( f ' River Basin
❑ OEA HHF J
AEC(s): Adj. Wtr. Body (nat /
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity r` 1
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
i
number
Bulkhead/ Riprap length
avg distance offshore ,
max distance offshord
Basin, channel �.
cubic yards
Boat ramp
Boathouse/ Boatl
Beach Bulldozing
Other
Shoreline Length __ 41 Y4— r, j
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no --
A building permit may be required by:
( 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 #
(Scale: )
❑See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature l� �i „` A
Issuing 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 I) 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 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

CERTIFIED MAIL -RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Mailing Address:
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawin the develo ment
thpare posing.have no objections to this proposal.I haveobjections to this ro osaP P 1.
bjections to what is being proposed, you mustnofify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 40
Commerce Ave., Morehead City, NC, 28557. DCai 2808representatives-can also be contacted at (252) 808-
. No res onse is considered the same as no representatives
if ou have been notified b Certified M " a11.
WAIVER SECTION
I understand that a pier, dock, mooring
back a minimum distance of 15' from my area of riparian access nlesslwaived ift, or rby musty set
wish aive the setback You must initial the a Y me. ({f you
y----______ appropriate blank beio
iCEIVED
i do wish to waive the 15' setback requirement.
- I do not wish to waive the 15' setback requirement. SEP 0 6 2018
-MHD CITY
(Property Owner Information)
dj 71,�PMpvrtyvwner Information)
Signature
PrinftrYpe Name
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Mailing Address
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City/StaZip
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Telephone Number
Date
Print or Type Name
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Mailing Address
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Telephone Number
Date
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CERTIFIED MAIL . RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
JACENT RIPARIAN PROPERTY OWNEIa NOTIFICATION/WAIVER FORM ORM
Name of Property ►tY Owner: ��
Address of Property: —9-2-97
twi or street #, Street or Road, City &County)
Agent's Name #:
Mailing Address:
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced
Property. The individual
applying for this permit has described to me as shown on the attached drawin the de
they are pro osing. velo�ment
en.
no objections to this proposal.
I have objections to this proposal.
If you have objections to what is being proposed, you mustnobfy the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mail
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at
mailed to 400
2808. No res onse is considered the same as no ob'ection if vehave been notified ht i`atF:FF.2
(252J 808-
I understand that a pier, dock, mooringWAIVER SECTION
back a minimum distanceboathouse,wish to of 15' from myna' f area oripa ant arcce s unlesslwa waive
must be set
waive the setback, you musal the appropriate blank below.) d by me. (}f you
—_� I do wish to waive the 15' setback requirement. eq ement.
I do not wish to waive the 15, setback requirement.
(Property Owner Information)
`ECEIVEI (Adjacent Property Owner Information)
7re S EP 0 6 2 Q �
le
PrintorT M-MHD C11 �I
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Date
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T elephone Number
Date
Revised 611812012

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