Bayliss, Thomas 77120C

CatVtA 1 JCRIAE[at3E 1t FILL 77120 A aCC
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GENERAL. PERMIT Prtaviouspertagt 0 _.._
�APNew '-­mo dtfication Complete Reittue 'Partial Remue Rate previous perittit
Ac asnironred t}y the State. of NotJ, Ca(olina, Department of Emirorlwtal Qva6ty
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"GMCAA /X-DREDGE & FILL N9 77120 A B 0 D
ENERAL PERMIT Previous permit#
1�lew ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / ¢-1 100
�"�j ules attached.
Applicant Name I I aM/A /��/I 1 S✓^ 141T Project Location: County Cg-�, {%
Address n / ' �/9 tt`P I^`C /w� l/ F / �� Street Address/ State Road/ Lot #(s)
City N{�it,✓ ��1 State f V ZIPS
Phone # (= (= 8115 E-Mail Subdivision f2r1 C.E'-5 l9 i
Authorized Agent
Affected ❑ CW N�fYf -&ffX_ ;RI S 0 PTs
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes. n PNA yes no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Groin length
number
ulkhea iprap length
avg distance offshore_
max distance offshore y
Basin, channel i—
cubic yards l
Boat ramp
Boathouse/ BoatliR
Beach
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes n
A building permit may be required by:
( Note Local Planning Jurisdiction
Notes/ Soecial Conditions i
** Please read compliance statement on back of permit"
Fee(s)
City
ZIP
C.C.S P
River Basin/ �-S
Phone #
( p))
Adj. Wtr. Body ri(l
eek IOOS nat unkn)
Closest Maj. Wtn Body
/VPaGIS V�
(Scale: /i�
See note on back regarding River Basin rules.
Bw
Permit Officer's Printe Name
Signatu e
791 2 6n - i 1/�y
Issui gDat piratio 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, 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
252-808-2808/1-888ARCOAST
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
I hereby certify that I own property adjacent to 2720mas anti s.5 's
(Name of Propel Owner)
property located at /2/ Shate0ii Dr•
h (Address, Lot , flock, Road, etc.)
ls on nc¢S cmek in Bern , N.C.
(Waterbody) (City/Town and/or County)
The a licant has described to me, as shown below, the development proposed at the above
locati loll
I have no objection to this proposal.
dotloop veri0etl
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)
.Zns�a!/ah`uvi o,� vinyl 6u1�� tD EDI7�'t.c.cf �c.�'K.�n
7two ex;5# hR.i�. &lij� fro'n'rbes,
RECEIVED
JUL 2 8 2020
DCM-MHD CITY
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.)
—s�— I do wish to waive the 15' setback requirement.
959 AM EDT
dotloop verified
I do not wish to waive the 15' setback requirement.
7j1 �ma s A [3"vG`ss
Print or Tvpe Name
G
— A-/_dy —
Telephone Number/email address
Date
di�ddvipv
07118209 59 AM EDT
QiAEZ4-M6D8-GROI
Signature
David Herminghuysen
Print or Type Name
119 Shoreview Dr. _
Mailina Address
New Bern NC 28562
City/State2ip
252-665-3986/ [e-mail]
Telephone Number/email address
07/18/2020
Date"
*Valid for one calendar year after signature*
(Revised Aug. 2014)

Cl 3V 19 .0 P Ff
YTID Ali -IM411)(i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 920M&S 13cw6`s5 J� Is
(Name of Prope Owner)
property located at /21 shopetripw Dr~
(Address, Lotl plock, Road, etc.)
on AHC s Crte4, , in /Ve..y QorA N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
ca ion.
l.' I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
andivldGalrproposing development must fill in description below or attach a site drawing)
.Zns/a!!�,{,`vn o.� viny( 6vlk�d !a ¢ohrt.ccl` dc��h
TW6 ex;sffng �jul(�ibeadS d'►1 h¢ oori �rO�/fies,
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.)
or
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
N'c 2f-5X; ..
nt Property Owner Information)
Ymll V/ � yNrr IVgllly
l.ilry/Jrare/Llp
252- — 5 --&1/ 5 - Telephone Number/ email address
Telephone Number/email address � I ` i I q �0I_
Date Date
(Revised Aug. 2014)
"Valid for one calendar year after signature*