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EModification ECompleteReissue IPartialReissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern Pu rsuant to l5A NCAC
Applicant Name Prolect Location:
D
Previous permit #_
Date previous Permit issred-
frcerrna/TDREDGE&FILL lqu N9 77154 AB@ENERAL PERMIT
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Phone #
Authorized Agent
Affected
AEC(s):
ORW:
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trOEA trHHF trIH
tr PWS'-
PNA yes
trES
tr UBA
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Street Address/ State Road/ Lot #(s)
Subdivision
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Phone # ( )
Adl. Wtr
Closest Maj. Wtr. Body
ztP,*Mib&kRiver
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Type of ProjecU Activity
(scate: l"= I 0 )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) -./
Groin length
number
Bulkhead/ Riprap len4h_
avgdistance ofirhor" 7
max distance offshore_
Basin, channel .-
cubic yards
Boat ramp
Beach
Shoreline Length
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:Eff
A building permit may be required by:E S". note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
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Agent or
Fee(s)
read compliance statement on back of
Check #
PermitOfficer's
Date
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Statement of Compliance and Consistency
This permit is subiect to compliance with this application, site drawinS 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 proiect site and accessible to the permit officerwhen the project is inspected forcompliance. 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 proiect is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certilied mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of Nonh Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, cenifythatthis proiect is consistentwith the North Carolina Coastal Management Program.
River Basin RulesApplicable ToYour Proiect:
I Tar- Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
E oth.r'
lf indicated on front of permit, your project is subiect 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 Olfice (252-946-6481) or the
Wilmington RegionalOffice (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Ofrices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
2s2-808-2808/ r -888-4RCOAST
Fax:[phone]
(Serves: Caneret, Craven, Onslow -
North of New River lnlet- 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, Pasquoank and Perquimans
Counties)
Washintton District
943 Washington Square Mall
Washington, NC 27889
252-946-648t
Fax:[phone]'78
(Serves: Beaufon, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 9 l0-395-3964
(Serves: Erunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ I 7
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to S{.,.f fuo,1 ilnn w,\s j
property located at Lltr d"kh^@n trr4
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vl (Address
on tn
(Waterbody)(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPME
(lncliviclual proposlng development mustfill in deac ptlon below or altach a
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I understand that a pier, dock, mooring pilings, boat ramp, breal$ater, boathouse, lift, or groin
must be set back a minimum distance of 15'from my area of riparian access unless waived by
me. (lf y ou wish to waive the setback , you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
(Property Owner lnformation)4vL t"in/
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(Adj acont Pro perty Owner lnformation)
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Telephone Number / email addrcss
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-
Date
*Valid fior one calendar year after signature'
(Revised Aug. 2014)
localion-,/L/ I have no objection to this proposal.
I have objections to this proposal.
N.C.
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I hereby certiry that I own property adjacent to afc^r aY ftnrt lut
property located at zl{ 0aE D,<
(Name of Propefi Owner)
ht 6a ''71ff"l4iress, Lot t/ sln,q , N.C
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on r.€,in
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the abovetocy..
I have no objection to this proposal
I have objections to this proposal
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I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15'from my area of riparian access unless waived by
me. (lf yoqlrw-ish to waive the setback, you must initial the appropriate blank below.)
./ il16\ ,o wish to waive the 1 s' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner lnformation)
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Name
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a^-/IDate 7 ft/ zo
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tvalid fur one calendar year after signature'
(Revised Aug. 2014)
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(Waterbody)
DESCRIPTION AND/OR DRAWNG OF PROPOSED OEVELOPMENT
(lndlvidual propoalng development must ftll ln desc puon below or al,E,ch a sfte dnwlng)
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