75509A_Childers, Michael & Deborah_20191211

qCAMA / rt DREDGE & FILL
r. GENERAL PERMIT
lj7iNew 'Modification ❑Complete Reissue ❑Partial Reissue
�JL_ V
No. 75509 A� B C D
Previous permit # -
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r7 /4
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
l ti4 Rules attached.
Applicant Name ' 6- C C � C a /� C �.' PJS Project Location: County l� C e
Address f '�' , B o," "? -i Street Address/ State Road/ Lot #(s) L o+
City�3 ✓ _-, '-� State (V ( zip Z7 7 ) S
Phone # E-Mail
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
�EW PTA DES
C HHF ❑ IH ❑ USA ❑ N/A
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
460o'
Application Fee(s) Check #
Subdivision
City --a ✓ o ZIP Z -7 ! IS
a
Phone # ( ) ` River Basin o s " �� a'^ All
Adj. Wtr. Body C a ^ "_( (nat (man Junkn)
Permit Officer's Printed Name
Sign
/ o
Issuing Date Ex ' tion 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/ 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)
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
I hereby certify that I own property adjacent to -�)e4 I3 1 J. Is
Name of Property Owner)
property located at n J i��O� L. A/
(Address, Lot, flock, Road, etc.)
on M L. i C in 110 Al , N.C.
(Waterbody) (City/Town and/or County)
The applica as described to me, as shown below, the development proposed at the above
locat
e"'o 0 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)
A
l 2,x lZ
p o ; g x
t '4 '
i
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 w ' e 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
QOwner Information) a ro Owner Information)
Signature i nature
t-A . lv'k f" f / - c-- ?�
Print or Type Name Print or Ty Name
Mailing Address 7'ing Address
City/State2ip City/Sta e/Zip _
asa -c-II
Telephone Number
►3 ��E Zo�9
Date
TelVJnumber
Z-�
Date
(Revised 6/1 &2012)
DAP

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f)P¢it,% 4 a - C U., I 1pay s
((Name of Property Owner)
property located at �u-) `> ' f A)Z
(Address, Lot Ml/,,
Road, etc.)
on N _� �/ �� (2 in N.C.
(Waterbody) (City/Town and/or County)
The appl nt has described to me, as shown below, the development proposed at the above
to ti
I have no objection to this proposal.{
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
^ _ r CSLAO
WAIVER SECTION I
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or grin must be set
back a minimum distance of 16 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 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
s' 'air� cE11V��--i
Print or Type Name
Ma' ing Address
�t�t�
Cit tatelZ
Telephone Afwnber
(&.6 )JOV '201 �I
t#Mrd
(A ent Property Ow177�
/ 2 .
Sig ature
�A ,n &-5 f
Print or Type Name
�!11 tr g� �ss � +aje r � ,
�Srl� r 4,/114r --� Ot-
Date
(fRevlsed 6/1 &2012)

This map is prepared
from data used for the
Op inventory of the real
•fJ property for tax
.% purposes. Primary
information sources such
as recorded deeds, plats,
wills, and other primary
public records should be
consulted for verification
of the information
contained in this map.
jp
513 ft
r, ,s,
39038 Tarpon LN
Owners: Childers, Michael D - Primary
Avon NC, 27915 -
Owner
Parcel: 013957000
Childers, Deborah M - Primary Owner
Pin: 064010269438
Building Value: $205,800
Land Value: $110,200
/� /, V
Misc Value: $3,500
Total Value: $319,500
m
Tax District: Avon
Subdivision: Hatteras Colony Sec 10
Lot BLK-Sec: Lot: 4 Blk: Sec: 10
Property Use: Residential
Building Type: Traditional
..,,
Year Built: 1987
L _ Al

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