Jackson, John 78324C

AMA / L1 DREDGE & FILL Wl '18324 A B %t J D
4G!
NERAL PERMIT Previous permit#lis ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality —7 /• 1 ra. ��
and the Coastal Resources Co misslon in an area of environmental concern pursuant to 15A NCAC El Rulqs attached.
Applicant Name(%� C I c (A'-� Project Location: County___-C
Address._ I —/ r_ Street Address/ State Roa /Lot #(s)_
Ctry_ � (QC. State ZIP_ f F1'J I
�Fh-f . �r
Phone # E-Mail Subdivision-j- _ _ —
Authorized Agent ___ City zllp--
,peW A ❑es ❑PTS Phone# (__)_____. River �Basin__-...+___
Affected [ C J
r OEA ❑HHF ❑IH ❑UBA ❑N/A ! �r9.� "`r{ a man unkn)
AEC(s): Adj. Wtr. Body. — -__-_
❑ PWS: T
\ Closest Maj. Wtr. Body
ORW: yes no PNA yes no I
Type of Project/ Activity J / v t� v c.
r3 x /3 l�
Pier (dock) length --�-,----i
Fixed Platform(s)
?/
Floating Platfoloffrshorel
Finger pler(s)
Groin length
number
Bulkhead/ Rip-
avg distamax distBasin, channecubic ya-
Boat ramp i -
Boathouse/ oatli
i
Beach
Other - _ \__
Shoreline Length �{—I,
SAV: not sure yes o
Moratorium: n/a- yes
Photos: yes
Waiver Attached: yes no
A building permit may be required by: _
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
-14 -TA
J Agent or
F ,
Please read
I � 1
I I �
i
I
Check #
[ -—�- (Scale: "/L.iT )
-I See note on back regarding River Basin rules.
1
_ __.._
Signature/
Issuing Date Exp ration ate

AMA / ❑ DREDGE & FILL N° 78324 A B / C / D
GENERAL PERMIT Previous permit# l/
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality —7 /� lq 6 16
and the Coastal Resources Co mission in an area of environmental concern pursuant to 15A NCAC
❑ Rul attachgd.
Applicant Name
�O C' Project Location: County C �f[7
Address
Phone # (�,_Q
Authorized Agent
Affected �;P W ,�g�y ❑ A
Affecte —EA C ❑ HHF IH
State ZIP d
all
❑ ES ❑ PTS
❑ UBA ❑ N/A
C RW: ( yes ) no PNA yes no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshon
Basin, channel
cubic
Boat ramp
Beach Bulldozing
Other '
(
Shoreline Length
SAV: notsure yes no
Moratorium: n/a yes
Photos: yes Waiver Attached: yes no /
A building permit may be required by: �l
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
/.f U'dl 0
Street Address/ State Roa /Lot #(s)
191 RDr-
Subdivision
City fie; ZIP a/2&It )6 /
Phone# O River Basin V t
Adj. Wtr. Body �/ `I'�""zk Vman /unkn)
Closest Maj. VAr. Body C 0UY"I,/
(Scale: N %� )
�,t f—T_ F�
Or
L' ❑ See note on back regarding River Basin rules.
-14 ---------------1
Agent or Applicant Printed Name PermitOf
K
Sign r *"* Please read compliance statement on backofpermit** Signature/ /
Wplication Fee(s) Check# Issuing 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, 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 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/ 1-8884RCOAST
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 MA IAN pLtopgjrjf y OWNER STATEMBINT
(Ie0RAIPIERIAIOO)UN(,'t'ILINGVIUOATLIL77110A t 10LISA)
i hereby comfy that I own property Adjacent to ; 1�re La�— 'a
(Nome (ifPrriporty Owner)
property located nt v_,
(Street Address, Lot, Block, herd, ore,)
—Ar ( body) ill (Cerra and/or County)
190/ahe Imdasaribcd to tn'e, oshown below, the development ItelAe is praposfng at that
location and have u ob actions to Chia 7o I understand that a plu/mporing
pilings/boalliPVbaot tauxc moat lve act ba`vT a nummum dfstanca al fiftrcn trat (I S j fr4tn mya{ as of
riparian aacass unless waivod by roo.l have hidtcatad myimentions Iyy6rfilnJlug betaw;
1 Q2infagrec to waive the 15' setback requirement.
(in 'att)
1 Aq agree to waivc the 151 setback requirement.
,als
. .............................
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVL?LOPMENT:
(TO be fill y try bidlvJdaal propoaing development)
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keo
:...._.._.._..............t._.._..........
St ee y��{�•-
{Tint or Type Nmtc
i cleplmne ��Numbar
fate;

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ADJACENT RR'AIRIAN PROPERTY OWNER STATE, MCI NT
(l%OR �t t�IGR/AIORtUNC I'IGINCS%ROfI'.f,G-l-1�'7'/ltOd y`I(OrUS'GJ
I hereby certify that I own property adjacent to J t71kIJ J(l�% SotLl s
(Name of Property Owner)
property located at _._�� �Aurf cD M
(Street AddrLss, Lot, Block, Road, etc.)
on_��I��FkUQS"f q- ,iu.
(Waterbody) ('fonu and/or County)
he/she hasdesetibed to me, as -shown below, Ilia development he/she is proposing at that
location end 1 have no objections to this_pro�Oml, -A understand that a pier/mporing
pilings/boadif9onthouse most be setback a minimum distance of fifteen rcet (I5') from lnyarea of
riparian access unless waived by me. I have indicated my intentions by inidaliag below:
I dry rtpt'agrec to waive the 15' setback requirement.
I do agree to waive the 15' setback requirement.
<�nitt ts)
Y MDESCRIPTION AND/OR DRAIVVING OF.PROPOSED DEVELOPMENT:
M befilled n by individual proposing development)
15 s ,rv�
150 rf
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PrinlorTypo Ncmrc r^C
717'c-)
Telephone Number
Date:

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RO. Box 249 • Havelock, NC 28532 • [phone] o Fax [phone]

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