Gallants Landing Assoc. 80423C

AMA / ❑ DREDGE & FILL NQ 80423 A B C
ENERAL PERMIT Previous permit#
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ew ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued
'�
As author zed by the State of North Carolina, Department of Environmental'Quality 9Y.-
and the Coastal Resources Commission in an area of environmental conce,✓4 pursuant to 15A NCAC l�
Shoreline Length ( C
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ kpepiaj Conditions ,
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t:z��A(n , �id P11 A
Age A plicant Printed Nam
Signature O e read compliance statement on back of ermit **
Application Fee(s) Chec
❑ See note on back regarding River Basin rules.
Signature r h�
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mg Date ftExpi-n 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, certifythat 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 complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] 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)
(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

Name of Property Owner Requesting Permiti
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Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Print or Type Name
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Title
Date
This certification is valid through
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ADJACENT RIPAR14 PROP ERTKQW—NER STATEMENT
I hereby certify that I own property adjacent to _d ��^ R S —__'s
(Name of Property Owner)
property located at_ J I �il! rjf Irtr Y' f3 F- ri --------- -___
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(Address, Lot, Block, Road, etc.) ��
,
on — ra—ll � ti _C rt/1 �' _._._, in _ gcoocoo r rtic car N.0
(Waterbody) (City/Town and/or County)
Then p licant has described to me, as shown below, the development proposed at the above
I or .
I have no objection to this proposal.
ItL
I have objections to this proposal.
[DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing developniont must fill irr description below or attach a site drawing)
v °� 1 Epn,�S
WAIVER SECTION
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 (if you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) JAdjat t Propert Oyvnar Irortnation) V
f eQ t _
Si Ire Vt,&saen Sir,*nulure:"
Print or Type N mo Print or Type Name
Mailin Ad ress lu- �� ng Acldrf; s �
if
City/State2rp { C ��le/Zr
Telephone Number email address 1"rlephone Nonber /eowd address
Uure 1)ur,
'Valid for one calendar year after signature`
(Rnvisod Auy. 1099)"
MAY 14 2021
DCM-MHD CITY

ADJAC'NT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f 3 OWR 9T �'�'C I
r1 (Name of Property Owner)
property located at J � 3 � � a (`I Q � / _
( (Address, Lot, Block, Road, etc.) Carf retce N.C.
on _ G-�t I All 15
C,Z in ly��J/-�/L7' lIG
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locajion,
�/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
,a I'L
WAIVER SECTION
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. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner information) (Adjacent Prop Owne In a "on)
607'
,�' criTClllfr('. .Si jl !/Tll'C ``
Print or Type Name Print or Tyne Name
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al ng Addre 2 llln Address
t� G u'� City/Statellip Cit /State2ip
S
2 s Z- ' 7 �3 -'9 It . coA\
Telephone Number/email address Telephone Number/ .mail address
014
/)aw cl ! Date*
(Revised"AMDgp
'Valid for one calendar year after signature'
MAY 14 2021
DCM-MHD CITY

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