Hathcock, Lindsay

CAMA / LJ DREDGE & FILL No. 74450
-. A B C D
GENERAL PERMIT Previous permit#
ONew ❑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 I SA NCAC
21 Rules attached.
Applicant Name ) . _ ';' } fv 1 ( r, �. Project Location: County V r ( i
Address - Street Address/ State Road/ Lot #(s)
City_ - State ZIP
Phone # ( ) E-Mail Subdivision
Authorized Agent City / — ZIP
Affected OCW ,SEW �7"PTA ❑ES El Phone O II River Basin �'✓C-((` v�.
AEC(s): OOEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body I I 1 "� _ . _ - (hat /man /unkn)
❑ PWS:
ORW: yes / no) PNA yes / no Closest Maj. Wtr. Body - --
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■■■■■■■■■■■■■■
Printed Name
Signature ** Pleasereadcompliance statement on backofpermit"
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Application Fee(s) Check # )
Agent of Applicant
Officer's Printed Name /
Signature
7 � /1
Issuin 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, certifythatthis project is consistentwith 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)
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)
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 LSv c1 i u� He +Ancoc if s
(Name of Property Owner)
property located at -7 41 V?eAs leu i av r
(Address, Lot, Block, Road, etc.)
on Chnl+oot CXeeIK in NAvc Iocl� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site
drawing)
Se-c U l+acVI ed
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 waive the setback, you must initial the appropriate blank below.)
k11A_ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature .Signature
I_1"d�HCA coCV \Al IIiutn,1 L YWaHtX
Print or Type Name Print or Type Name
ChPAi IP.i A Lu Vim
Mailing Address
Ilovelock tNc 246532-
City/State2ip
�Ict"1 3eUs 1e�1 Lavte
Mailing Address
Hcwe(uck,NC 2t3S32
Ctty/State2ip

252 (n-10 3t54
Telephone Number
yS- 1-1-Zoe q
Date
&182012)
Z gz- Cod { L2�
Telephone Number
9//`1//°7
Date
(Revised

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I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at 1 Rl 3eai l ern Lc,vi e
(Address, Lot, Block, Road, etc.)
on LI,Abfjo- week in Page-toc.lc� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
ocatioy.
V/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site
drawing)
Sc,e G {-Each ed
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 waive the setback, you must initial the appropriate blank below.)
V_A— I do wish to waive the 15' setback requirement.
&— I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature
Print or Type Name
-19n Bens Ie -) LGV1 e.
Mailing Address
Have'(cc.lc- PAL 2�532
MJr .1r•
Signature
NAZWflIct r LJILaIWS
Print or Type Name
1 )S Sec l�vi Lc-V,
Mailing Address
—Oa - Ioc,lz.NG 20532_
City/State/Zip City/State/Zip

252 VIC> 3s54 Q5a• 9riI_gpsS
Telephone Number Telephone Number
OS i I ZGl9 )ci• 15
Date Date
(Revised
611812012)

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