Harrison, Cleve 78349C

W
AMA / 'DREDGE & FILL N9 78349 A B � D
NERAL PERMIT Previous permit#
ew ❑Mdification ❑Complete Reissue ❑Partial Reissue Date previous permit 'ssued
As authorized by the Statoe of North Carolina, Department of Environmental Quality
and the Coastal Resources Com�ni sion In an a e of environmental concern pursuant to I SA NCAC
(/ J' ❑ Ru s attached.
Applicant Name �GIrC,Orr (/ �^ Project Location: County
Address Street Address/ State Road/ Lott #(s)
City_ fr VV / State. trL ZIP _ _ w J�J --
Phone()E-Mail Subdivisii
Authorized Agent _ CiZIP-
Affected ❑CW tKW A ❑ES ❑PTS Phone# (_) iver Basin
AEC(s): OOEA ❑HHF ❑IH ❑UBA ❑N/A Adj. Wtr.Body U t` "'i nat a /i unkn)
o PWS: X
ORW: yes / no PNA yes /ro Closest Maj. Wtr. Body --y,
Type of Project/ Activity J_) LA /(c t1Y�' elf
(Scale: r—. )
Pier (dock) length r
FixedPlatform(s) k
Floating Platform(s)_ _. _
Finger piers) j__
Groin length
1 ,
T 11 '.
er I
ulkhead/ prap length
dstance offshore
max distance offshore t t _ - ' -y _I _ i- - ±-
i
� r t I
Basin, channel
IIII t �
cubic yards
Boat ramp
Boathouse/ Boatlift
�j �
Beach Bulldozingj
Other
tj
t I
- t
Shoreline LengthI-�i—
SAV; not sure yes n I 1
Moratorium: n/a yes no I : I
Photos; yes o _
Waiver Attached: yes o
A building permit may be req fired by: ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions 1 (�( '� ✓ `^ C `� `U� ���^ /HS
G L! S P, ..r.2
—
Agent or Applicant Printed NamePermit Officer's P n e Name
, / _
•*'Ip'a;ereadcompliancestatementonback ofpermit ek Signat e—
l//U
xpiration
Application Fee(s) Check# Issuing Da 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
Iandowner(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 consistentwith 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/ 1-8884RCOAST
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 Pander Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

(property Owner Information)
/ s A
Signature p
Print or T e Name
Ming AddressZzje
City/State/Zip
a2S� lv�o - q�ro
Telephone Number
/ ;grj IgoZD
Date
ADJACENT RIPARIAN PROPER�tTY OWNER STATEMENT
G�'s
I hereby certify that 1 own property adjacent to (Name of Property Uwner)
property located at
(Address, Lot, Block, Road etc.)} N.C.
on in CFC��1s0
(yyaterbody) ((;ityliown andiv, County)
The applicant has described to me, as shown below, the development proposed at the above
location./
i./ 1 have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELttachOPMa T
(Individual proposing development must fill in description below or attach a site drawing)
WAlvi=_R SECTION ------
__ _..
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be se
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.)
X___ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
or Type Name
Address I
City/statal ip
Telephone Number Z D
Date
(,Revised 6/18/2012)

ADJACENT RIPARIAN PROPERTY OWNER STA.�NT
I hereby certify that I own property adjacent to/�
(Name of Property Owner)
-property located at etc
(Address, Lot, Block, Ro.Ln,� N.C. .
on in
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
F% I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
IRA146 i
WAIVER SECTION _ -- - —e
set
I understand that a pier, dock, mooring p`iiarea ofeakaraaessounless waved by me (If you
back a minimum distance of 15' from myriparian
wish to waive the setback, you must initial the appropriate blankbelow.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
,
Sio ature
C. AyR }-(r4dviSo� —
Print or T e Name
,alai 'ng Address
2-c :i- /./Je�z�✓i i�� � d 5102-�
City/Stateip
Telepho/ne'/Number
Date
Owner imonild.,v­
City/State/Zip , �¢
Telepha e Nu er
�Z ' Z✓
Date
(Revised 6/18/2012)

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