Morgan, Tim 78279C

i4AMA / F] DREDGE & FILL M 78279 A B - C
ENERAL PERMIT Previous permit #
ew LiModification JComplete Reissue ! ]Pardai Reissue Date previous permit issued
� As autho ized by the State of North Carolina, Department of Environmental Quality W.ulw
and the Coastal Resour s Commission in an area of environmental concern pursuant to 15A NCAC.
Applicant NameProject Location: County.... ---
1 Street Address State Road/ Lot #(s) _...._.
Addre _ ..................... ,
City State._- ZIP,._._
_ j
Phone #� �) �'---...... Mail SubdiviSipn L�.... a � .-
Authorized Agent
CW W TA C ES PTS
Affected OEA HHF ❑ ,--!;USA C N/A
AEC(s):
PWS:
ORW: yes / no PNA yes
Type of Project/ Activity
--
Waiver Attached: yes C r-
A building pen -nit may be required by:
( Note Local Planning Jurisdiction) ,
Notes/ Special Conditions
x
l.. t -- ---- ...........
/ jPlease read comPILAce stateryw4nton back of permit
Fee(s) Check?/
City_ _ ZIP_
Phone # .. _ ..... River Basir
.
Adj. Wtr. Body... .:._...1+ ,
Closest Maj. Wtc Body.....:._, . _ ,.........,,
Si natur
�s uing ate
(Scale: I ! ,'V )
�-7
`+ See note on back regarding River
�3 10 2021
CM-MHCITY

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 I) 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, certifythatthis project is consistentwith 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 howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth Citv District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, CurritAk,
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I M YC.= {' a �` V 's
(Name of Property caner)
property locatea a. ;
(Address, Lot, Block, Road, etc.)
on __T-�'Iov, -..in _T-'_)r3c�c ic-
Waterbody) (City own and or County)
The applicant has described to me, as shown below, the development proposed at the aoove
location.
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 si
9� 'A
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse. ut<, or aroir
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. cif 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 Property Owner Information)
Y _
Sigmaire.{
1"t
Print or Type Name
Mailing Address nn. 7CC22 c
City/ate/Zip
C-119 • 3G.q • 1 z.rtC-1 k;�tic4hu,lc�L� Ci,�r: Cct-1
Telephone Numb r / email ad ress
—UL -AJra�o z 0 "._'.EIVED
JAN 0 5 2021 AN p 5 2021
Signature
dk /Ut /� C" , S h, J A -
Print or Type Name
/ L� l) a N7" "v g *v
Milina Address
j�
City/State/Zip
Telephone Number / email address
Date* 11 1 %
(Revised Aug. 2014)
UCM-MHD CITY i'"F,0 .ri rn CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ' va t _ r-"% 's
(Name o Pro erty Owner)
property iocatea at Lr, , , �� 1 t
Addr ss, Lot, Block, Road, etc.)
N.C.
(Waterbody) I (City wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
N�� I have no objection to this proposal.
I have obiections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
e4
1 l)
VI�AIVER 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)
Signature
Print or Type' Namc
15LI - mac.�a l�r.
Mailing Address
NO-
city/sate/zip
Telephone Numbe /e VED
iilz z� 7:C.
Date
JAN 1
(Adjacen rope Owner Information)
Sir tUre
Print or Type Name
/56 f/i,,,
Mailing Address
City/State/Z
TelepponeNumher / email address
/// 2
Date *
(Revised Aug. 2014)
DCM... OITY

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