Long, John Jr.

❑CAMA / ❑ DREDGE & FILL N0, 76393 A B C D
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
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name P L C
Address
City State ZIP
Phone # ( ) E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no ' PNA yes / no
roiect ocation. ounty
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body t ' Oat /man /unkn)
Closest Maj. Wtr. Body -
Type of Project/ Activity -
------- _---7:--
(Scale: � )
Pier (dock) length -----
i
j
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length•
,
number
I
�
Bulkhead/ Riprap length d
avg distance offshore
_
DCM
max distance offshore
f
Basin, channel
i
—
j
cubic yards
I
i
Boat ramp
r`
Boathouse/ Boatlift
j
Beach Bulldozing
I
Other
i
Shoreline Length 1 '
SAV: not sure yes ,- no
Moratorium: n/a yes nc,
Photos: yes_ no i
t
Waiver Attached: yes no
�(� J°
A building permit may be required by: I..At- n:^,.d� ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions r•.
Agent or Applicant Printed Name PermitOfficer's Printed Name
Signature "Please read compliance statement on back of permit" Signat re
_ r
Application Fee(s) Check # 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 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, 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/ 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
s
I hereby certify that I own property adjacent to (Narrte of Pr rty Owner)
property located at 406
(Address, Lot Block, Road, etc.) ` N.C.
in
on-a-n�/. (Cityrfown and/or County)
(Waterbody)
The applicant has described to me, as shown below, the development proposed at the above
to �n_
I have no objection to this proposal.
I have
- --- -- DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION ----- - -- - -
- - understand that a pier, dock: mooring pilings, bLeakwater, boathouseslsa wor aived you
l
l;
back a minimum distance of 15' from my area of riparianappropriate blank below.)
Foive the setback, you must initial the approp �p� 2 Z020
I do wish to waive the 15' setback requirement. DCM-MHD CITY
do not wish to waive the 15 setback requirement.
(Property weer Information)
(Adj ent roe 0 r information)
e
t or
1V ailing Address
m L / /JC 27 9
City/State2ip10
`
Telephone Number
Daia
or yp Ala
ig ljddrpss P -'1 Y
Teleph ne Nu er
0
D t
(Revised 6/18 2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
�.�—r,��nfl�r,L I hereby certify that I own property adjacent to " (Namoperzy owner)
property located at
i (Addr ss, Lot, Block, Road, etc.) NC
on in ��v � �, > >y���� s '
County)
(Waterbody) (City/Town andlor
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
---
i hate objections t_o_t.b:is_pcopos:aL___�___- ._-------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or aftach a site drawing)
L
cp v
�o
WAIVER SECTION .-------=--
- - I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin
back a minimum distance of 15' from my area of riparian access unless waived by
wish to viaive 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
(Property -Owner information)
�L 1�
' 1 c
Sio tore
Print or TyP e ame
2,23�'c ss
Mailing Address
CitklStatelZip
Telephone Number
�F1'-7y© e�z5
Date 4-9
15' setback requirement-
must be set
me. (If you
RECEIVED
2 s 2020
(Adjacent Property OwneT inforrma6on
C-IUIFID CITY
hianature
Print or Type Name
am 1/6�- Y'5
Mailing Address
Grzh.yyfle, 2 %f�
City/State/Zip
Telephone Number JAf
(,Revised 6/18/2012)

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