Machle, Chris

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification Complete Reissue Partial Reissue
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
Applicant Name- � � Project Location: County
;
Address' t Street Address/ State Road/ Lot #(s)
City 4> State —ZIP {7
Phone # (_)` E-Mail Subdivision
Authorized Agent _ City---- -
Affected ❑ CW 71 EW 0 PTA ❑ ES ❑ PTS Phone # ( _ ) _
AEC(s): ❑ OEA HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body
❑ PWS:
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no
No71621 A
Previous permit #
Date previous permit issued
Rules attached.
ZIP
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
F'.� -- 1-1
PermitOfficer's Printed N
�' '�-"�'%'.r!N°• ter.
Signature /
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 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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
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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I hereby LA certlty 2(0 O �(�C ddress, dot, BIOcK, �Lt np ndlor COunty)
prOpehy located at C�E�K lA , in ---'(Clty1TOW meat 'Proposed
at the above
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me,
licant has described to psal.
The apP to this prop
I have no objection MEN'
locat, i°n' osal DEVIFILpp
to this prop D attach a site drawing)
objections OSE
1 have DRAWING OF PR�below °r N A D 11�
— N ANDIOR ust fill in description 2'
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(T Z WAVER SECTION
dock, mooring pilings, boat ramp, breakwater, boathouse, jjf � or �r01�
I understand that a pier, ,
must be set back a minimum distance Of 15 frOm my area Of riparian acceSS unles
me. (if you wish to waive the�etback, you must initial the app4priate bi"ankbelo5 waived by
�
I do wish to waive the 15' setbackrequirement.
X I do not wish to waive the 15' setback req�remen
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(Property Owner Information) (Aq�e
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
CNfZ1SY019t}Ea pMOUlam' 's
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IFArMC P N�.
property located at i �
(Address, Lot, Block, Road, etc.)
on (7IDE0A) CREC K in PAYMU CO QUIVTV N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
X_ 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)
UT►LlZlnlF-)�ISTN& P►LlNt S IN W)FTc2t AND 4PD►IV6,
PIL►NGs% svPPoRis As REPERa0cF-D IN 4f lncnEo D►2�wIrVGt
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F—)tTtfYS(ViV TO El<)sT 1 NU P1 EP, AND A 3 t W W09PEN
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6'6. , 2-" ( '� 11 WOMD YY DECXIN G y- 6 Q+ VE(?T1C,4L- Q)C jtn &S150aPO>zTS.
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.
X I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature Signature
C_081-5191OHE12 MACHUl - 1*�ARr/4A MISKE
Print or Type Name Print or Type Name
cf 2(00 0AW49) CI?EEK Rk 1424 Sf ORCHARD CREEK RD.
Mailing Address Mailing Address
0Q) F-NT4L- N G 28S7i VtI EIUr,4L , NC 2 fs571
City/State/Zip City/State2ip �.
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Telep one umb r/email address Tele hone Pumber/email address
Datl Da e*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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