Wood, Jackie 79518C

CAIVIA /-MREDGE & FILL 16 #') 7Q 41
GENERAL PERMIT Previous permit #
❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission i an area of environmental concern pursuant to I SA NCAC /
�} ` a ul�s attached.
Applicant Name [ / C � f T � � ' Project Location: County
PP
Address -V l `�/ '
l Street Address/ to Road/ Lot #, )
Ci C ►"'� State ZIP /
ry
Phone# )��E-Mail Subdivision
Authorized Agent 1/V`r/'• ��Z ��� City r t ! or ZIP O/`0,
❑ CW `� -O'PTA ;� ElPTS B V
Affected AEC(s): ElOEA 6HHF ❑ IH ElUBA ❑ N/A
❑ PWS:
ORW: yes no/ PNA yes no �
Type of Project/ Activity 6—
Pier (dock) length`/
Fixed Platforms) xr
Floating Platform(s)
Finger pier(s)
Groin length
61k�h=ag/R-t.
distance length
offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ ecial Conditions
t
Phone # O River asin
Adj. Wtr. Body n /man /unkn
Closest Maj. Wtr. Body-
2 () n
❑ See note on back regarding River Basin rules.
�t �'
Agent or Applicant Printed Name PermitOfficer'S inte Name j
I
e 7 Please read compliance statement on back of permit Signature
ionFee(s) Check# Issuing ate E piratio 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 howto 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 - (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico Tyrrell and Washington Counties)
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)
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

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: .J Ol C h, i e—
Address of Property: y 6 (6k@ P t Q JP r 7t 61[ APy
(Lot or Street #, Street or Road, City & ounty) �(�
Agent's Name #: � l) ro,) w-e-A - Mailing Address: �� %y i? Oak.
Agent's phone #: o� J :� �� oc 4iJr IV til�wtl �r� d� J y) 0
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
the are proposing. A description or drawing with dimensions must be provided with this letter.
T have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htta //www nccoastalmanasrement.net/web/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you WV
hto waive he 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)
4
_S nature
Print or Type Name
Mailing Address
bl e. Cc,t,-,� ra-
City/S te/zip 0 0,& de e , r r• . c,rrr �-
��
Telephone Number/Email Address
(Riparian. Property Owner Information)
/ A V,,� X,.-�,
Signature
i h, Le rv) a
Print or Type Name
Mailing Address
!tly/Stlp
--10 q (v so g 6 5 4
Telephone Number/ Email Address
1 /19/2021
Date Date
(Revised Aug. 2014)

F �

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: J Q (' k i t �� 0 0 CX
Address of Property: "� y 0
nI (Lot; or Street #, Street or RoadCity & County) p
Agent's Name #: /)Q V � �J h ca 6 t Mailing Address: -1 I 1-
Agent's phone #: � ,5� �l U ��� U,� '�LU��1 V,
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
V� L' 1 Have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htta://www.nccoastalmanapement.net/web/cm/staff-listtnp or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
' - 1r
S nature
:11c t�10d
Print or Type Name
Mailing Address
City/S te/ZipW
Telephone Number/Email Address
Date
(Riparian Property Owner Information)
Signature
C I n e-
Print or Type Name
1 iling Address
A(�
City tate/Zip L� '1 y I,'
3 0(r� � I 1 �?
Telephone Number/ Email Address
Date
(Revised Aug. 2014)

ADJACENTP N PROP ER ST TE 4
i hereby certify that 1 own property adjacent to ;; Is
propertyJ(V(Name Qi roperty Owner)
Located at 7 4� l. � {�.'�
1 y , 1 (Address, Lot, B! k, Road, Ito.)
on �`� r \ ' ()Ok �-t�4 in E'- I tk N.C.
(Waterbody) (Ci 1Townand/orCounty)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must ti/l in description below or attach a site
drawing)
An uJusivrt of exis+hn� dock while
MOJMNn original hrrvia+/ layow+.
WAIVER S��110N
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, 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.)
1 do wish to waive the 16 setback requirement
1 do not wish to waive the 16 setback requirement
(Property Owner Information) (Adjacent Property Owner Information)
) ct �V/ '�V 42� V V r cis
ignature Signature
Print or Type Name Print or Type Name

i
n
a
3
v

M�alllIng' Address?,
- %1-5-�-- -(a—
colwateop
mu
Telephone Number
Date 3 `J I 1
&r1tT/2012)
Malllnp Address 1
colvatwvp / p
nt IA I
Telephone Number
Date
3 -"-( -, i rr��lsed

ADJACENT P I N PROPER ER 8T iEM
I hereby certify that I own property adjacent to I
property located at "i ff(Tame Qt,P petty owner)
(Address, Lot; Block, Road, eto.)
on �—�jCv y �IfLv' in N.C.
(Waterbody) Cit Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(fnd(pfduat proposing development must fill in liescrfptfon below or attach a site
drawing)
An QZ%+zhSiorl of 161 -o e9WHrl5 dock W1111i7
mai0rilihaI forrncx-h�ow+.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of IV 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 Owned Information) (Adjacent Property Owner Information)
g rntune f, fc t C' .c:� srgnn�Ty
Print or Type Nam Pdnt or Type Name

Mailing Address n/ f
GItylstataop
Telep Number
Date 1
611812012)
Mailing Aditss
�
c ( a
TelepL Number
Azle
(Revised

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