Meadows, Thomas 78350C

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RAL PERMIT _ Previous permit #
Mew ..:Modification iComplete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �//!,/
and the Coastal Resources Com fission in an area of environmenta concern pursuant to 15A NCAC VC/
M LJ Rul s attached.
Applicant Name U/' ' ' ��'G/ �/� Pro'ett Location; Caun v
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Address_ (j, �� i� Street Address/ S ate RoaPot,�V(s)
City- / e J�
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Phone # ( _� ! _ - all _.— Subdivision --- -
Authorized Agent U `1 1^ r , C'✓`J v
- ( -- City / --- zip L
Affected CW - EW _ PTA �5 C PTS Phone # (_ _) _ _ River asin
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AEC S ; 1 Of~A Li HHF IH UBA N/A (ate VA�/t
(} Adj. Wtr. Body _ man unkn)
i PWS.
ORW: yes /(no) ! PNA yes 1 J�o j Closest Maj. Wtr. Body- - _ 7-�- -
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)-___-_-
Floating Platform(s)
Finger pier(s)--
Groin length
Bulkhead
Bulkhead) Riprap length
offshore
max distance offshore
Basin, channel
cubic yards _
Boat ramp _ __
Boathouse/ Boatlift
Beach Bulldozing
Other— __- _._
Shoreline Length
SAV: not sure yes ?no
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Spe ial Conditions
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Agent or
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*'t Please read compliance statement on back of permits *** .
Fee(s) Check #
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J•See note on back
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Signat� /f
Issuing Da
(Scale: /9 )
�/,—pjration 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
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 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

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NC Division of Coastal Management
Cashier's Official Receipt
Received From: 0Ay_•1
Permit No.: C7p,�`I�
Applicant's Name: IQry��s
Project Address: /63 J&4+ Dc" Sim ","
14014 A BQc D
Date: 20 PIL
$Im—
Check No.: &qQa7 —
County: a19, 1. )
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant:
Signature of Field Representative:
Date: