Toms, Jeff 80080C

Scarrne /fi DneocE & FILL
GENER/AL PERMIT
&N"* EModification EComplete Reissue IPartial Reissue
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Phone # ( )-e-y"it
N9 80080
Previous permit #
Date previous permit issued
ABCD
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to
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Applicant Name Project Location: County
Street Address/ State Road/ Lot #(s)
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Subdivision
Authorized Agent
Affected n cw
AEC(s): tr oEA
PWS
ORW: yes / no
City zt?
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tr HHF
! PTA
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tr PTS
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Phone # (_)River Basin
Adj. Wtr,(nat /man /unkn)
Closest Mal. Wtr. BodyPNA yes / no
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Type of ProiecU Activity
(Scale:)
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) '
Groin length
number
Bulkhead/ Riprap
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV:not sure yes no
Moratorium:
Photos;
Waiver Attached
nla yes no
yes no
I yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Y See note on back regarding River Basin rules.
Notes/ Special Conditions
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Agent or Applicant Printed Name
Signalyre ** Please read compliance statement on back of permit **
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PermitOfficer's Printed Name
Signature
Application Fee(s)Check #lssuing Date Expiration Date
city- State-
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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 subject the permittee to a fine or criminal or civil action; and may cause the permit to become
nullandvoid.
This permit mustbe on the proiect site and accessibletothe permit officerwhen the proiect is inspected forcompliance. The
aPPlicant certifies by signing this permit that l) 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 Nonh Carolina and the Division of Coastal Management, in issuint this permit under the best arrailable
information and beliel certiry that this project is consistentwith the North CarolinaCoastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - PamlicoRiver Basin Buffer Rules f] othe.,
Neuse River Basin Buffer Rules
lf indicated on front of permit, your proiect 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 (257-946-j481 ) or the
Wilmington RegionalOffice (910-795-7215) formore information on how to complywith these buffer rules. zfl
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
2s2-808-2808/ | -888-4RCOAST
Fax: [phone]
(Serves: Caneret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth City Distrlct
401 S. Griffin St.
Ste.300
Elizabeth City, NC 27909
2s2-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washintton, NC 27889
2s2-946-6481
Fax:252-948-M78
(Serves: Beaufort, Benie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
I 27 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7715
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://ponal.ncdenr.org/web/cm/dcm-home
Revased 7/06/17
I hereby certify that
property located at
on
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I own property adjacent to
of
Road,
'S
, N.C.
(Waterbody)(City/Town and/or ntv)
The applicant has described to me, as shown below, the development proposed at the above
'"9+11 I have no objection to this proposat.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividual proposing development must fill in description below or attach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 you
wish
ldo
setback. vou
sc,"l/t "\wish to waive
must initial the appropriate blank below.)
the 1 5' setback requirement
I do not wish to waive the 15' setback requirement
r)(Property lnformation)
nature
Print lLD(
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Date
7
Date
(Revised 6/18/2012)
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Craven County GIS 1 inch = 50 feet
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r Complete items 1, 2, and 3.r Print your name and address on the reverse
so that we can return the card to you,
r Attach this card to th6 back of the mailpiece,
or on the front il space permits.
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C. Dat6 of Deliv€ry
D. ls dellvery addrBs difldent from item 1?Yes
lf YES, ent€r delivery addrsss below: E No
3. SoNIca Type
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A. Signature
AA E Agent
E Addressee
1. Arlicle Addressed to:
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iltillt iltl]ilililt]iltI illtil il1il ]tIilt
9590 9402 5585 9274 4662 69 tr Conmed Mail B$lrict€d Dollvery
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SEI{DER: COMPTETE THIS SEcrtoN
PS Form 381 1, Juty 2015 psN Tsso-02-0oo-90s3 Dom6tic Betum Rocoipt ,
COMPLETE THIS SECTION ON DELIVERY
ADJACENT RIP ARIAN PROPERTY OWNER ST TEMENT
I hereby certify that I own property adjacent to v
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prop located at oc
dress, L lock, Road, etc.
on ,tn , N.C
(Waterbody)(City/Town and/or
Ine app canl nas oescnoeo Io me, as snown oerow, ule uevelop renr prupustsu ar urE auuvE
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANTYOR DRAWING OF PROPOSED DEVELOPMENT
(lndividual propcing developnent must fill ln description below or attach a site drawing)
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WAIVER SECT]ON
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance ot 15'lrom my area of riparian access unless waived by me. (lt you
wish to waive the setback, you must lnldal the appropriate blank below.)
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I do not wish to waive the 15' setback requirement.
(Property Ow
Print or
)(Adiacent Proporty Owner lnformation)
Signature
Pint or Type Name
/ Mailing Address
city/stateEip
s
/
"'*ge?Yy: / t Telephone Number
(Bevised 6/18/2012)
Craven County GIS
ilCr.vrnCountyd6sNOTwlrEntthclntormslionEhownonthltmaprndshouldbrurcdONLYforlsraarortmonlputpoEos. PrintedonMaEh9.2021 815:il,l:30PU wffihft-q}*
'1 inch = 50 feet
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