78579A_Houser, Jimmy_20200324

lilCAMA / 1 DREDGE & FILL N9 78579 V'�- 0 B C
GENERAL PERMIT Previous permit#
®New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ey
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / N
O Rules attached.
Applicant Name ,}'m YA �4 i
Address
City (krifor Cr, State ,` ZIP �1L1
Phone # (, `/U) 5 3 3" '7 1 39 E-Mail
Authorized Agent
Affected ❑ CW NEW ® PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity _
Project Location: County t
Street Address/ State Road/ Lot #(s) La4 53
Subdivision j� VC rS Gc�G 11
city H(- 1Jr zip
Phone # ( ) River Basin
Adj. Wtr. Body .4 ! e 9.Cat Jma /unkn)
Closest Maj. Wtr. Body Ljberr�o5or-s ^
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NI I A building permit may be required by: CO Lk rl See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
LA IL
Agent or Applican rinted N e
C.
S�natu ease read compliance statement on back of permit"
aco
Application Fee(s) Check #
CAAi4i A4-1-r
Permit 7r' Printed N�e�
(f/�
Signa re
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 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/ I-888-4RCOAST 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

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: , ) I m rvrn
Address of Property: 145 H P-f t YOr
(Lot or Street #, Street o Road, City & County)
Agent's Name #: 7-3 Ob bJ i w k I +&, Mailing Address: 107
Agent's phone #: oi5 -`? �7- S O )! N e_✓ +�FO►^!� . ou C, it �
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 this 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. Correspondence should be mailed to 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. 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, 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.
Z
pey Oe Information)
Si at re
Print or Type ame
q a t) ifo_ W G V
Mailing Address l —
H
City/State/Zip
c�q0-5�53—T739
Telephone Number
311-7 /,9
Date
(Adjacent Property Owner Information)
Sig e J,� (,
-J(�`",
Print or Type Name
3,3
Mailing Address
C 24zly
City/State2ip
ZSZ— Z32-10.? ---
Telephone Number
.3-- Jy-2*
Date
Revised 611812012

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7-2

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Ji rh my H005e r
Address of Property: I y S D+i-Qr Way 4t
(Lot or Street #, Street or Road, City & County)
Agent's Name #: — o — �i �'Q- Mailing Address: 107 ('preSS La,oq
Agent's phone #: )5,,z 33-7 S`u1 f}Q(+-po✓�
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 this 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. Correspondence should be mailed to 1367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. 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, 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 Omer formation)
Ign-aft e 11 II
J t ►'v1 ✓h �/ �1 d JSs d
Print or Type Name
l N 5 0 ++-,1 vray
Mailing Address
H �r� G(I �- -7 y y
City/State/Zip
—1c �V ),y0-5 3-7?39
Telephone N tuber
�o ono
Date
(Adjacent Prope y wner Information)
Signature
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Print or Type Name
All CV��
Mailing Address
r
City/State/Z
��
Telepho e 7,,r
Date
Revised 611812012

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