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AMA / ❑ DREDGE & FILL
�'�)G NO 77134 A B ® D
NERAL PERMIT
Previous permit#
ew ❑Modification ❑Complete Reissue
❑Partial Reissue Date previous permit issued
As aut orized by the State of North Carolina, Department of Environmental Quality 7 �
Q
and the Coastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC /
Rules attached,
Applicant Name V1 V MlAf7i AC-1
Project Location: County �AVg4
Address T7 7rn K141P A Z
Street Address/ State Road/ Lot #(s)j0lo 3���JYC
City co
'iA j I—Y State ZIP
Phone # ((p) E-Mail
Subdivision
Authorized Agent
F'06
j Hi U\1PI'Ll
CityAOLC 1 0%A/9, ZIP
w w � PTA �S ❑ PTS
Phone # ( ) River Basin
-
Affected
AEC(s): ❑oFA ❑HHF ❑IH ❑UBA ❑N/A
gdj.Wtr.BodyQ�{a/�(
at man unkn
❑ PWS:
ORW: yes no PNA yes no
Closest Maj. Wtr. Body 1
Type of Project/ Activity
Pier (dock) length_ f 2 4
Fixed Platform(s) tt
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
cubic
Boat ramp
Beach Bull zin
Other
i
Shoreline Length 1.J
SAV: not sure yes !,
wy
Moratorium: n/a yes /}N_,�;�
Photos: �yesV
Waiver Attached: V no
A building permit may be required by:
( Note Local Planning furisdiction�
Notes/ Special Conditions ITIi
or
V
•s' Please read compliance statement on back of permit **
Fee(s) Check #
r
(Scale:
IEr
:e �t I(
rr�
Mtx./iirtir✓t _
See note on back regarding River Basin rules.
c
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 how to 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: 252-247-3330
(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:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
'910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
httP:Hportal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17
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RECEIVED
AUG 07
DCM-MHD CITY
'I: i ..
• �' '
0
ADJAGEN I tUrI In rRt7PER1 Y Vyy 'r-D 21"I'"231
I hereby certify that I own property adjacent to �� Mfi A/ZflC' s
(Name of Proporty Owner)
Property located at'.2-
PVi z
]�.,n (Address, Lo
(Waterbody)
Al C— -
own and/or County)
N.C.
a li nt has described to me, as shown below, the development proposed at the above
1 w .
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTI®N AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing albqp1opment must )711 in descripSon below or attach a site drawing)
or-
T:�;PflL�rc-�
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 ive the setback, you must initial the appropriate blank below.)
wish
wish to waive the :95' setback requirement.
I do not wish to waive the 15' setback requirement.
pe caner Information) (Adjac n P arty Owner Inf nn on,
di
or Type Name Print or Type Name
naa J 9 re �G M�rnyacVdreU yN�� DRT✓E
Ci(fJl�lSiaiE/Z/p ' !'A�lcsalonin
Telephone Number elephone Number '
Date Date
(Revlsed61IN,d12)
31
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ADJACENT R P R N PR0�5+' V o Awnor)
I hereby certify that I own roe o¢ pro _�---
P p rty adjacent to (N
Property located at �a2 G J O �� f � ek Road etc-) G N,G-
Mo
on /�. AAA s 602 (Address. Lo� VP(drrown and/or County)
(Waterbody) in (city
The applicant has described to me, as shown belOW, th
e development prgposed at the above
I have no objection to this proposal.
I have objections to this proposal.
LOPMENT
(individual proposing
VE
AND/OR DRAWING OF PROP®SEp ®E
>lopment must rill in descriPGon
pelow or attach a site dratvirrfql
O is
/✓ A144 /.2 ' x/6 '
0'� /D� xe4-14 Grp
0 S k ',;?ot:�r i, i-F- -
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be sett
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 inFtial the appropriate blank below.)
I do wish to waive the) 5' setback requirement.
1( I do not wish to waive the 15' setback requirement.
(Property O mer Information) cjAd�acnnt Prop@rtv Owr�pP inf., ,+I=i
- ..
13
Print or
n® Number
_2 62 O
Dar".
uy'
---- � $zgL" .rhlt�Q .
Pnnt or ype Name
YE 55
Mai'z Address _
hon Number
Date
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