73813A_King, Terry & Mary_20190606

CAMA / DREDGE & FILL
GENERAL PERMIT
XNew El Modification L1Complete Reissue ❑Partial Reissue
No. 73 813 1L___
B C D
Previous permit #
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 N. 11uv
Rules attached.
Applicant Name lere t-ti �,, ,.•
Address —PO &k OW 5
City knit �s I51...t4 State 1%._(ZIP
Phone # CKI) (o35-3 ito S E-Mail
Authorized Agent
❑ CW
J EW
0 PTA K ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
C PWS:
ORW: yes / Ana.
PNA
yes b-no
Project Location: County
Street Address/ State Road/ Lot #(s) 1,�
L1 k4 .. sa# I a 9 9
Subdivision $ e rha L .
City r0 C� ZIP �kD
Phone # ( ) River Basin it
Adj. Wtr. Body To Cc ps. e -� e ( (...K) (nat /45Z)/unkn)
Closest Maj. Wtr. Body C� Y r • I� S� -
Type of Project/ Activity
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MOMMEMEME
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Agent '-Applican Printed
L
Signature asb read compliance statemen on back of permit
4►+Utz.oJ - — I u3
Application Fee(s) Check #
or
Permit ed e
ure
'1`11019
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
Neuse River- Basin Buffer Rules
Other:
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 complywith 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/ 1-888ARCOAST 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

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: V ' n) ►j 1 �.rq
Date:
Permit #: j -�g I 3,A
Describe belo',�r the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Sh��t,1•+�'
Dredge ❑ Fill ❑ Both ❑ Other
1 d 0
C)
Dredge ❑ Fill ❑ Both ❑ Other K
I
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmana ernent.net revised:02/03/10

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -Te-cy--1 I
(game of roperty Owner)
property located at 1 � � Wt\k�G�S �n�
(Address, Lot, Block, Road, etc.),
on , in I-�nr2tS 17-:'>1Oin d N.C.
( aterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
- ` 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)
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
e (If you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or 7type Name
PyC-x>< bs
ailing Address �� " p
4-,-`��(NCt 1o<_ i2 a t
Cl /Stat /Zip
,7�tozs-34W
Telephone Number/email address
Date
(Adjacent Property Owner Information)
Signature
5-
Print or Type Name
Mailing Address
�/A-
lam, .Z3 S/4
Telephone Nuinper/email address �4y
�.� / ..7 7r ,-, 1
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T W/-'r /(� XL�' 's
(Name of Property Owner)
property located at 1 ,25- k-1.Z-1'1"J7 S
h , (Address, Lot, Block Road, etc.)
on k1i (S�`�' in NoW5 :ZS64AV� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
!oc
7 I have no objection to this proposal.
I have objections to this proposal.
DESCRWTHM ANDIOR DRAVVtMG Of PROPOSED DEV ELOPMENT'
(lrxfivxW pnVosing deevelopmmt must fill in description below or attach a site dmwmg)
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 ou wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
"I
Print Prin�pe Name
Mailing Address
Kncrs T�'--4w
City/St te/Zip
(,i (P 35 -3q kg-f
Telephone Number I email address
to - Z Lf -('.
Date
(Adjace It Property Owner Information)
Sign�itLer%
Print or Type Name
1�I WZL> )>vZ
ailing Address
W0 279So
City Sta e/Zip
7- s,5f/-5?
Tate hone Number I email address
F-1 .2,,-- / q
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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