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DGE & FILL
PERMIT
ew IModification IComplete Reissue EPartial Reissue
by the State of North Carolina, Department of Environmental Quality
and the Coastal rces an environ
Applicant
Address
Phone
Authorized Agent
to l5,A NCAC
N9 79624 A
Previous permit #
Date previous permit issued.
.1$ rec
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Prdlect Location:
Street Address/ State Road/ Lot #(t
Subdivision #
City
Affected n cw
AEC(s): troEA
fI PWS:
\""trlH
Phone
Adl. Wtr
Closest Maj. Wtr. Body
EW IES
tr UBA
tr PTS
NN/A
ORW: yes /PNA yes /
re l*1fr read compliance statement on back of permit x*
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Basin
Tnre of P roiec6l Activity
)
Pier (dock) len4h
Fixed Platform(s)l:r r+F r_T-T
Floating Platform(s) _
Fhger pier(s)
Groin lengh
number
Bulkhead/ Riprap length
II+tl
L_j_LI
avg distance offshore
max distance offshore
Basin, channel
cubic yards b
Boat ramp
Boathouse/ Boatlift
I
Beach Bulldozing_
Other H r*t*1*L
1_
Shoreline Len4h
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
yes
yes
yes
yes
:i]lttt
A building permit may be required by:on back Basin rules.
( Note Local Planning I
^)
Notes/ Special Conditions
no
no
Fee(s)Check #
I
Permit
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As
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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 subiect the permittee to a fine or criminal or civil action; and may cause the permit to become
nullandvoid-
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies bysigningthis permit that l) priorto undertaking any activities authorized bythispermit, the applicantwill
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 adiacent 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, certifythatthis proiect is consistentwith the North CarolinaCoastal Management Program.
River Basin Rules Applicable To Your Proiect:
I othe.,Tar - Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
lf indicated on front of permit, your prolect 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 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 Oflices
Morehead City Headquarters
400 Commerce Ave
Morehead Cit/, NC 28557
2s2-808-2808/ | -888-4RCOAST
Fax: 252-247 -3330
(Sewes: Carteret, Craven, Onslow -
Nonh of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth Ciq/, NC 27909
252-264-3901
Fax:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-72t5
Fax: 9 l0-395-3954
(Serves: Brtrnswick, New HanoYer,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ I 7
Ncr. 75797 A
Previous permit #
Date perpit issued
B DIT
f Modification fJComplete Reissue lPartial Reissue
by the State of Nonh Carolina, Depanment of Environmental
and the Coastal Resources
Applicant
an
Project Location: CountY
Address/ State Road/ Lot
Subd
c
Phone #
Adj. Wtr.
Closest Maj. Wtr.
Phone #
Authorized Agent
City
Affected
AEC(s):
DCW
rJOEA
ZIP
River BasinDES
tr UBA
trPTS
DTVA
C
ORW: yes /PNA yes I
\
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-l
I-l
I
Basin rulesnote on
(Scale:
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/t
t75',Y,3
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;)to
I
Type of ProiecV Activity
Pier (dock) length
Fixed Platform(s)
----Floating Platform(s)
Finger pier(s)
Groin lengh _
number 1i-I'Bulkhead/ Riprap length ___
avg distance offshore._
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Eulldozing __,_-
Other
Shoreline Length
SAV: not sure
Moratorium: rVa
Photos:
Waiver Attached:
yes
yes
yes
yes
A building permit may be required by:
( Note Local Planning Jurisdiction)
Special
no
no
no
Agent or Applicant Name
**
ih*,*
Fee(s)
compliance statement on
Check #Date
& FILL
to l5A
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