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ENERAL PERMIT Previous permit#
Y- VI New ©Modification Li Complete Reissue [Partial Reissue Date previous permit issued
As autho 'r ed by the State of North Carolina,Department of Environment and Natural Resources �f
and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC -9/a /Zov .
les attached.
Applicant Name e8/4}i/L6 7/1 n0 b S Project Location: County p iu vE 12
Address )7.0. 2 6141 toStreet Address/State Road/Lot#(s)
City S A ( i State NO_ZIP Z 5043 601 Z
Phone#(9/(a Fax# ( ) Subdivision B/4A)d. ShOi' '-`.,
Authorized Agent PY)Al2 K. CLUGrii fVT City SU IZp-- 0 t _ ZIP , -BY .S
Affected ..p..crw jitEW J VTA 2ES PTS Phone# ( ) River Basin [ e-f- -19 z
❑OEA ❑HHF ❑IH ❑UBA N/A
AEC(s): Adj.Wtr. Body 71: // .S01.v14:21. (nat /(iitunkn)
❑PWS: ❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj.Wtr. Body Dr n/G SUuwD
Type of Project/Activity ri u/9- �},eIZ
/ (Scale: i ft=
Pier(dock)length_ 6 x 4 � )Q
4
Platforms) Y�( y I I, —T —..
____ 1 �_.-
Finger pier(s) i I i i- I I I
Groin length + 1 - 'i 0
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number p2, o I I , I to _ i •
Bulkhead/Riprap length I /� I { i ?`�'
avg distance offshore 6rrriti .L_._ 0 :I -
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max distance offshore ;
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Basin,channel I —�
— , l I �r C ‘�Crgb`
cubic yards I l • . 12
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Boat ramp — . — I
- X/2 I''
Boathou - `" �, Si ♦ i
if
iiii.MONIM ID
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Beach Bulldozing Q __1111111■111111•11■, I • —
/ 4 I s
Ocher g X /G FLDAT f ,y di si I
Pi- ' �' + 6 . i,
_—._ _. I
Shoreline Length .
SAV: not sure yes no V , 4 �—
Sandbags: not sure yes no I i. i ' I—r
IT 3 —
Moratorium: n/a yes no I
1
Photos: yes no 1 Waiver Attached: yes no - I 1 f
A building permit may be required by: 3 ../2 P (lam . / . E See note on back regarding River Basin rules.
Notes/Special Conditions MR Y AlO7 Etc Q-t-1 4 am-kn. 60d y W i Q17�-/ c ii g)(/�T/N,
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-- • Appli /i'nted N e Pe ' ••tcer's Signature
'Infix,k l -1< /y/0- 03 7 /O —O3
Signature **Please read compliance statement on back of permit** Issuing Date Expiration Date
/& .00 .c z Z suet' (,r 1' QO 0454
Application Fee(s) Check# Local Planning Jurisdiction Rover File Name
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•
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,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 Quality. Contact the Division of Water Quality at the Washington Regional Office(252-946-6481)or the Wilmington
Regional Office(9 I 0-395-3900)for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District Washington District
Mailing Address: 1367 U.S. 17 South 943 Washington Square Mall
1638 Mail Service Center Elizabeth City, NC 27909 Washington, NC 27889
Raleigh, NC 27699-1638 252-264-3901 252-946-6481
Location: Fax: [phone] Fax: [phone]
(Serves: Camden,Chowan, Currituck, (Serves: Beaufort, Bertie,Hertford, Hyde,
Parker Lincoln Building
Dare,Gates, Pasquotank and Perquimans Tyrrell and Washington Counties)
2728 Capital Blvd. Counties)
Raleigh, NC 27604
9I9 733 2293 / 1 888 4RCOAST Morehead City District Wilmington District
Fax: [phone] I5 I-B Hwy. 24 127 Cardinal Drive Ext.
Hestron Plaza II Wilmington, NC 28405-3845
Morehead City, NC 28557 910-395-3900
202-808-2808 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Carteret,Craven,Onslow-above Onslow-below New River Inlet-and
New River Inlet-and Pamlico Counties) Pender Counties)
www.nccoastalmanagement.net Revised 10/05/01

kx_ein.EinaLirijyjtj UlnYIEUTER FORM •
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-ADDITIONAL NAI.ES: fi4d14--04A/vb2444s
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• DIVISION OF COASTAL MANAGEMENTc52
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ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of individual applying for permit: 3 ` a.a,r_o6 5
Address of property: G� ��-1 �� a�2GLPi� 5
I hereby certify that I .own property adjacent to the above-referenced property. The individual
applying for this.permit has described to me as shown on the attached drawing the development
they are proposing. (A description or drawing, with dimensions, should be provided with this
letter.)
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North .Carolina, 20405 -or. call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
•
WAIVER SECTION
(Does not apply to bulkheads or rip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags 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.)
I do wish to waive the 15' setback requirement
do not wish to waive the 15' setback requirement.
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Signature Date
Print Name
336
Telephone number with area code

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of individual applying for permit:
3 ` 3Z e
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Address of property:&� �,�� [%��
C
1
I hereby certify that I .own property adjacent to the above-referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. (A description or drawing, with dimensions, should be provided with this
letter.)
I have no objections to this proposal.
•
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, North Carolina, 28405 or call (910)
395-3900 within 10 days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mail. •
• WAIVER SECTION
(Does not apply to bulkheads or lip rap)
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags 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.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
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Signature Late
�gri-7 L L.V
Print Name
/ ? 06
Telephone number with area code

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