Brisson, David

®❑CAMA / ❑ DREDGE & FILLI INO. I5968 A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑PartialReissue Date previous permit issued
As authorized by the State of North Carolina, Department of En,�Onmental Quality
and the Coastal Resources Commissi n in an area of enviro;penW concern pursuant to 15A NCAC
ly � �JRules attached.
awA' Name 1 " f �.-y f 1 ) Project Location: County
Street Address/ State Road/ Lot #(s)
City ! (_ %/ ( / J! C' / Sate f l l ZIP , f ) `'_ // i' 'i
Phone #
Subdivision
Authorized Agent ^— City ZIP
Affected ❑CW IJEW A El ES ❑PTS Phone# (4)River Basin _
AEC(s): ❑OEA hHHF �I ❑UBA ❑N/A Adj. Wtr. Body (nat /man_ /unkn
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Agent or Applicant Printed Name PermitOfficer's Printed. Name
Signature ` Please read compliance statement on backof permit** 11 1 Signat�itionDate
C 1Application Feels) PCheck # Issuing Date x,

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 maysubject 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 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
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
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)
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Revised 7/06/17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to --oG ccJ Hr' din e4 's
// (Name of Prop! Owner)
property located at �OZ � �`/ L4t yj cv�ar
(Address, Lot, Block, Road, etc.)
on �J�C,'� J�o��✓, in i(:'P"5,0o r7 /U ( , N.C.
(Waterbody) (City wn andlor County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
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)
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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..
1 do not wish to waive the 15' setback requirement. --
ro-perty Owner Info1 tion) (Adjacent Property ner Information)
or
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City State/Zi ' 1,7, 3 �
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Date
'Valid for one calendar year after signature
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LlAI// Hr -flD //f 's
/ (Name of Proper Owner)
property located at �a9 � �% G�IGC� 'Aj&
I (A dress, Lot, Block, Roadetc.)
on O -L JOr�rt Q in �_�_, N.C.
(Waterbody) (City/T6wn andlor County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
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)
6 jx3&ei D'o � -tip y
J-�42T T 11-) 1
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.
I do not wish to waive the 15' setback requirement.
(PPo�wne�ion)
Si e
Print or Tvoe Name d
manuilrF��7D r� /{ �� Z�ii`5�
-..'.-------- 7/0'- a r 3 as -/(
Telepho a umber/email address
ti v `6
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Unre" ll//g/RRECEIVED
9
(Revised Aug. 2014)
DEC © 9 2019
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