Jackson, Robert (2)

116AmA�1.❑ DREDGE & FILL NO. 75959 A B C D
®9 NERAL PERMIT Previous permit#
ew [-]Modification []Complete Reissue []Partial Reissue Date previous
permit issued
As authorized by the State of North Carolina, Department of Environmental Quality /�� /2 G' /
and the Coastal Resource Co mission in an area of environ ental concern pursuant to 15A NCAC ` CCC///
�- ❑Rules $ttached.
7 !_.: !! /
Applicant Name Oi = i - ( i Project Location: County ( '% P^
City L If. 4 A ' 1^
Phone #
Authorized Agent
C
Ey Mail
ZIP
Affected ElCw [-;Ew -,ePTA ❑ ES ElPTS
AEC(s): OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes no PNA yes /I no
Street Address/ State Road/ Lot #(s)
Subdivision
City �r , ZIP }
Phone # ( ) River Basin
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Agent or Applicant Printed Name
Signature " Please read compliance statement on backofpermit"
Application Fee(s) Check#

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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMIAIVER FORM
Name of Property Owner: Z24�� ,. �` �S c—
Address of Property:
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(Lot or Street #, Street or Road, City'& County)
Applicant phone#:gip='' �1(�''�31a9 Mailing Address:
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 drawing the development
they are proposing. A description or drawing. with dimensions. must be Provided with th[g letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangementne(IcontoeLdcm.htm or by calling 4-8884RCOAST. No
response Is considered the same as no objection If you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
Yla%,
7V--.�o4 ^ Ap-m
Signature
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Print or Type Name
Mailing Address .
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Date
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Madirl0 Address
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Telephone Number
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Date
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I hereby certify that I own property adjacent to
property located
s
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On E PCB in n �11.P f�G N.f .
(Waterbody) (Cityfrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. -
v� I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description brelow or attach a site drawing)
WAIVER SECTION
1 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.)
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)
.Si_onature r a
Print or Type Name
Telephone
Date
(Revised 61182012)

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'/CAMA / i DREDGE & FILL No 73193
A B / C7 D
ENERAL PERMIT Previous permit# `�
6VNew i :Modification I ;'Complete Reissue I ,Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality _ /r /al/
/ j
and the Coastal Resources Commission in an area of a vironmental concern pursuant to 15A NCAC / l J d V
•1n' i}Rules attached.
Applicant Name l'�, Q��r� �C L Project Location: County Ce.-�r/te
Address �� {"'3'/ Street Address/ State Road/ Lot #
City f -Y �t StateVA-ZIP au«y l� J tJ oc,4,r X r- 0)"
---- ---._. --.
Phone # x- b f-Jl1�E-Mail�.� _ - Subdivision /t >
Authorized Agent �DoAlel✓) 4 fe✓5wl City vcrlenJ
1CW W +!flA : ;ES ; ;PTS Phone # (. ) River
AEC Basin V_ 4+v''LJA�
Affected r
s : OFA ; HHF ! : IH i ; UBA ] N/A
Adj. Wtr. Body yh CfC_. JDN�� to [maq [unkn)
PWS. Closest Maj. Wtr. Body cU", ✓t�
ORW: �� no PNA yes /(� �'ty L
Type of Project/ Activity
Pier (dock) length y1% 3/ V
Fixed Platform(s) D Y -to
Floating Platform(s)
Finger pier(s) '..
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp �(
Boathouse/ Boatlif 15X 1 J
Beach Bulldozing
Other �7
Shoreline Length / / ,fit
$AV: not sure yes
Moratorium: n/a yes M�Yr
Photos: yes l"}9(
Waiver Attached: You
no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions Yf /
6 'X
ltF.1-
G t.4-Itpriz6r0
SOAll n M411 � v�
Age(:
Si or Appplia tPrinted Name
y` ,tru"PleaeereadcGlickta�te�me/nt on backof permite*
hod , `I
Application Fee(s) Check #
(Scale:,,./ -7T )
1! i 1 i % I
fe I� �0- &Ki CJe (/hC��If�ft'4
J Ou^�i PoiM�Y
_ See note on back �regarding River Basin rules. ilocri0n A-1/a C k
{ C-1 V/
Permitoff er's ' t Name
Signatu
VVVVVV 111146
Issuing Date
E3i�io�n'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 howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City uartprj
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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, Bettie, 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 Ponder Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

Davenport, Ryan
From: Robert Jackson <[e-mail]>
Sent: Wednesday, December 11, 2019 2:57 PM
To: Jim Johns
Cc: Davenport, Ryan
Subject: [External] Re: Bentley Brooks acting agent for Robert Jackson
Ryan - I hereby authorize Bentley Brooks as my agent in lieu of JoAnn Mangum to pay for the permit. Thanks
for your prompt attention. r/Bob
From: Jim Johns <[e-mail]>
Sent: Wednesday, December 11, 2019 2:08 PM
To: Robert Jackson <[e-mail]>
Cc: [e-mail] <[e-mail]>
Subject: Bentley Brooks acting agent for Robert Jackson
Bob,
Ryan and Bentley was at the property today,
Ryan has your application but needs you to send him an email assigning Bentley as your agent to pay for the permit and
have it issued for you.
Thanks,
Jim Johns
1

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