Kozel, Debbie & Mejia, Andrew

XCAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Uffila_New iJModification ❑Complete Reissue Partial Reissue
No. 76387 A B CC D
Previous permit #
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 1 SA NCAC 07t(, /la0 :�E 0711
Applicant Name ��p ®Rules attached.
IQi__K .._ __ Q {� j Project Location: County n 5 'o W
CityAddress--1 7�- ' � Street Address/ State Road/ Lot #(s)�
City -�� Clk1 el_WState _�CZIP — -
Phone #(WO)376-,qWE-Mail Subdivision
Authorized Agent ��'�('tjt�t- City_-----_ ZIP
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Affected (_—) — . River Basin
AEC s :El OEA CJ HHF IH ❑ UBA J N/A ,/
O Adj. Wtr, Body (_t/_ -_ n man unkn�
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it Printed Name
Please
Fee(s)
statement on back of permit
Check #
Permit Officer's Printed Name
Sign ure
Is ing Vate Expir ion Date

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.. I�ICAMA / ❑DREDGE &FILL
GENERAL PERMIT
ew ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern
Applicant Name D ^
Address 1
City S n p 1' CV State_ / ZIP o
Phone # O E-Mail
Authorized Agent
Affected -'rcW -4EW "rA � ❑ PTS
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes / io PNA yes no
pursuant to
No. 76387 A B (0 D
Previous permit #
Date previous permit issued
15ANCAC ©711, /16>0 ,�- o71 • r �J
®Rules attached.
Project Location: County (Q Al 5l O Vd
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP _.
Phone # (. ) River Basin
Adj. Wtr. Body /V ,ye_�_ n man unkn
Closest Maj. Wtr. Body S
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Signature Please read compliance statement on back of permit
Appl� Fee(s) Check#
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Permit Officer's Printed Name
Sign urger
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Is ing qate Expir ion 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
Iandowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat 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 Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-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

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Must be set back a minimum d oe RcQe
of 1 #ro- my area'Of riPa�� l�€ � unless waivesi y
: , . (If YOU wish to waive the setback, YOU Must Initial file apprOPOMO bleak beioviit.)
l CIO wishtiv t1��2k� requirement,
f'. , — l do not wish to waive the # W` setback requirement.
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