Clark, Terry 79575C

®PlbAMA / El DREDGE, & FILL N9 79575 A B CC D
G NERAL PERMIT. Previous permit#
Kew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 711 0 C'
and the Coastal Resources Commission in an area of envirgnmental concern pursuant to I SA NCAC
—7� / / / / ElRu es attached.
Applicant Name i �,f r• / (i 6Y c Project Location: County — . ) rl-.
(, -i State/l ZIP ci 4 t
Phone # (�1?) % 1�'.E-Mail
Authorized Agent c ! (Ire f /
Affected El OW" -p.EW —rC TA ❑ES ❑PTS
AEC(s); ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: o i es PNA yes
y �/
Street Address/ State Road/ Lot #(s)
/( ^11 'Y
Subdivision y
City �r 6 ZIP 0
Phone# O Rive Basin
Adj. Wtr. Body —IL,/ T � ' n Kat /man /unkn)
o
Closest Maj. W_.
r . Body —
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moos
Agent
:i
Sipitre r Please read compliance statement on back of permit
Fee(s)

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, certifythatthis 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
252-808-2808/1-888-4RCOAST
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:Hportal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
W
MovckCa4 ALC -(,- '�s-s-`1
17 p G l�th� f Ya Q a
to act on my behalf, for the purpose of applying for and obtaining all CA`MA permits it
necessary for the following proposed development: qt Wit^ �Z ,Soon
n�
at my property located at U Zg5l,Z�Lac�tf- /_�Z<N C-0 u[r
in County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information _related to this
permit application.
Property Owner Information:
Signatur
DER C4(4a
Print or Type Name
Title
Date
This certification is valid through
RECEIVED
JUN 2 S 2021
DCM-MHD CITY

ADJACENT RfP 80-16 PROPERTY OV1tidER STATEMENT � s
I hereby certify that i own Property adjacent to -<(Nam ro l C L/r1)
property located at ,_ Ic i Address, Lot, Block Road, etc.) N.C.
in
on l `"� a' ' tcr{y(Town and/or COWRY)
(Waterbody)
has described to me, as shown below, the development proposed
The applicant at the above
i ro osal.
�7J I have no objection to this p P
M19PMMT
have obiJts?9
- DESCRlp-nON AND/OR DRArJNNG Of PROPOSED DEVELOpt�R a site dravrir��j
n'
- — u I fill in descriptions betQtrw orat�c� a
(Individual proposing develcm� e S '�\ fr
� \� SS ✓ `' � iJ� S.
VyAtVER SECTION . or ruin must be set
ilin s, breakwater, math unless waived by me. QAt 11SVED
1 understand that a Pier, dock, moonna P ny area of riparian access
back a minimum distance ot a] the appropriate bhnkbelow-)
wish to waive the setback You musJUN 2 S 2021
1 do wish to wane the 1 setback requirement.
DCM-MHD CITY
do not wish to waive the 15` setback requiremani.
. _orrrsa*ion)
(propertyey Owner Information)
eWloop.err�d
- a l/212'30 PM Eor
�a[ n/�,, esaltrztnr.EvaE1a
S aonature �A
ytir Judy L Dudley
— Print or Type iName
rJudyDudley �eYry Clar()—
MailingAddress
9199066063, ��� O
I elepnuuc 1„L1,• i' fib" 1 --
5/7/2021 _
�-� Date
(Adjacent ?roperty Ovmer In1
=
Scott Auman
EaT
a"/nntsa-,
M,-
xwiawele amcrnrov
�4,07=Ura
�r ared J. Lanier
Scott L. Auman
✓' Print or r YW am
100 Magens ct. E
104 Magens Ct. E
Mailing Address
t rodar➢nint. NC 28584
Cedar Point --NC 28584
5/8/21 5/12/21
(R,,,Ased 5/1 g/g012)

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