Mulik, Jimmy 77384C

,CAMA/ ❑DREDGE & FILL NQ 77384 A B C D
GENERAL PERMIT Previous permit#
1 New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality i
and the Coastal Resources Commission in an area of environ entsiI concern pursuant to 15A NCAC
1 / ❑ Rules attached.
Applicant Name Project Location: County r _
Address 2. l✓ - ( "
City State A/C
Phone # (^2 1- I�7 _Mail
Authorized Agent
CW
❑EW ZPTA
❑ ES ❑ PTS
Affected
AEC(s): OEA
❑ HHF ❑ IH
❑ USA ❑ N/A
❑ PWS:
ORW: yes /%no
PNA /yes / no
4
Street Address/ State Road/ Lot #(s)
Subdivision
City
Phone # O -
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
River Basin C
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Agent or Applicant Printe Name Permit(
4
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Signature •• Please Yead compliance statement on back of permit** Signatu
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Application Feels). Check# Issuing
c Pri ned Name -
'i o
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, 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 ❑
❑ 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 complywith 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, Cravens 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

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or
Applicant phone #:
o� Roaii, City & County)
Mailing Address:
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 must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact—dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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.
(Property Owner Information)
Sf natre
Jammu �/„l,
Pri�Type Name
?02 t e,4a I Or
Mailing Address
c-vrrrnalz LL /VC o2i
City/State/Zip
9/el- .27/- 712
Telephone Number
/J- 7-'20�?Q
Date
(Riparian Property Owner Information)
-c J. 'IL = i> �, -
Signature
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Print or Type Name
Mailing Address
City/State/Zip
13 C - 7 ()-1 3 ,'6n
Telephone Number
Date

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIA P OPERTY OW ER NOTI ICATION/WAIVER FORM
Name of Property Owner: f , OleYe
Address of Property:
(Lot or Street #,
Agent's Name #:
Agent's phone #:
or Road, City & County)
Mailing Addres : 6 bd X 40)
f'wuwd�( Sit NL AM
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, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastaimanagement.netlweb/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wis to waive the setback, you must initial the appropriate blank below.)
4 A40 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
I9> S gnat e
Print or qpe Name
Mailing Address
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City/StatelZip
9/-?-.Z71-7/,?-7
Telephone Number/Email Address
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Dale
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Date
(Revised Aug. 2014)

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