Casey, John 80557C

`LAMA / [-]DREDGE & FILL N9 80557
-� A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 15A NCAC f
L]Rules attached.
Applicant Name J ( i)-% '�"
,�,-7 )a✓n .�
Address_
City_ _ �r� �'/! State 6 ZIP
Phone # ( _) /��— 113 E- ail
rl /�
Authorized Agent } fir' ' I ') I )✓ va '
Affected d.CW ❑EW ©4TA El ES ❑PTs
AEC(s): 171 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision ,
City G/ i : !i'� ZIP
Phone# (_)River Basin 64,162
Adj. Wtr. Body G / I J U 1. C(nat /man /unkn)
Closest Mal. Wt„ Body
NONE
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
T
Application Fee(s) U Checks I
PermitOfficer's, primed Name- y-,J
Signature ----'�
Issuing D to Expi ation 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, certify that 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
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 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 Pander Counties)
http://portal. ncdenr.org/web/cm/dcm-home
Revised 7/06/17

7 CAMA / ❑ DREDGE & FILL No 80557
-� A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 15A NCAC
❑ Rules attached.
Applicant Name Project Location: County
City State ZIP
Phone # ( ) I E-Mail
Authorized Agent
Affected ElCW ,EIEW El PTA ❑ES ❑PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Street Address/ State Road/ Lot #(s)
City ZIP_
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit*•
6
Application Fee(s) �/ Check# j
Permit Officer'sjPrinted Name
Signature
Issuing Date Expiation 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, certify that 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 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 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://portal.ncdenr.orglweb/cm/dcm-home
Revised 7/06/17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to J o Fir,1 Pae r ( (n5GV 's
(Name of Property Owne
property located at tU' ClU W !l 5� i�1A7Z5f 1A LL ('1(, , C .
(Address, Lot Block, Road, etc.)
on G� R )OotV , in �1hK5r+b4 u., iZ6 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
local, n.
T 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)
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.
r
_ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Dare
`Valid for one calendar year after signature'
Prgp" Owner Information)
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Mallinggdd_r 05x' G'a 3mB7
City/staJe/ZliGG_KK-- 7
Telephone Nu ber/email address /7Gr
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Dare
(Revised Aug. 20f4)

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I hereby certify that I own property adjacent to _
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property ��
/located at (rnwn—
on Core C-- (Addresn,
N.C.
The applicant has described to me, as shown below, the development proposed at the above
local. iqn.
I have no objection l0 this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING Of PROPOSED DEVELOPMENT
Ondivldual proposing development must fill In description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, rift, or groin
must be set back a minimum distance of 16 from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must Initial the appropriate blank below.)
X I do wish to waive the 15' setback requirement.
do not wish to waive the IV setback requirement.
(Revised Aug. 2014)
'Valid for one calendar year after signature'