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c0AST,4, ❑LAMA ❑ DREDGE & FILL N9 87664 A B C D
y GENERAL PERMIT Previous permit \
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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 �' 1 t ' = ` ' ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name 6 V,F ? / �Y c
Address
City ; ; ! L 6 �^ y State ,/t/C_ ZIP 7' ' f (U
Phone #
Email
Authorized Agent 1
Project Location (County):
,
Street Address/State Road/Lot #(s) �tt /t e111./
r
Subdivision
City ZIP
Affected ❑ cW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ly
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length 4
Pier (dock) length i
Fixed Platform(s) 14 <��
Floating Platform(
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
E
SAV observed: yes no
Moratorium: n/a yes no:
Site Photos: yes no,
Riparian Waiver Attached: yes er no
A building permit/zoning permit may be required by:
Permit Conditions
/, .
(Scale /,r` )
1�'�,r �i ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
1 Ci{�^ ❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Nam Permit Officer's PRINTED Name
4 ;�"
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date
Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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:
F] Tar - Pamlico River Basin Buffer Rules 1-1 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. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
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 — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

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Preliminary Wetland Boundary
(approximate)
Notes: 1. Wetland area shown has not been surveyed. Area shown is to be considered approximate.
2.� Wetland area shown may contain Coastal Wetlands Upland limit of wetland Is noted to be
boundary of '404' wetlands and upland land area.
3.) Wetland area has not been reviewed by the US Army Corps of Engineers and is to be
considered preliminary in nature. If proposed encroachment or impact Is proposed, a
Jurisdictional Review (JD) by the USACE is recommended prior to site specific planning or construction.
4.) Clearing In '404" wetland area should be done by cutting vegetation any. No mechanical
(root disturbing) clearing is allowed. Use of construction mats and non -tired vehicles should be
used to remove cut vegetation. No clearing within Coastal Wetland Area Is allowed.
Map adapted from site plan provided by client
Ballast Point RD, PIN 4224-35-0847-0000 FIGURE:
Applied Keeource PreliminarrNyWetland Boundary
Managcment, I" C. JOB: SCALE: DATE: DRAWN BY:
HampoUnd, NC 28443 21049 1 "= 5G 2/1 /2021 GY

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to S'�'ae.QIk e 4_ TQf Y1 ,s
t ( ame of Pr p rty Qxvner)
property located at w�" :� A � 36 ! 6 , e 2 �3-,��7�,7,.b000)
on �j(lQ �(r F-- Address, Lo , Bloc , Ro , �Trftc.) J��
in Wl t'-�rno�-tom (0 W K N. C.
L-J(Waterbody) (City/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.
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)
t G at- ` l v"-" `"-
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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.
4'zq I do not wish to waive the 15' setback requirement.
(Property Owner information)
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city tat p
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Te'phone Number/email address
1-'7-- U V
Date
*Valid for one calendar year after signature'
(Adjacent Property Owner Information)
Signature *
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Print or ypeLName
Mailing Address
A4 o rq qe? V 26'5oS
City/sta /Zip
_(.30Lt) 612- 3c ly/5te3tal{znevMeeeSlt,nef
Telephone Number/email address
Zoe/
Date*
(Revised Aug. 2014)

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Dafe Received
Date Deoa M d
Check From Name
Name of Permit Holder
Vendor
Check number
Check
mount
Permit Number/Comments
Receipt or Refund(Reallmeted
Column!
Column2
Cdumn3
Colu-4
Column5
Columns
Co1umn7
Columns
Column9
12/8/2022
Sound Side Marine Construction LLC
Harvick
First Citizens Bank
178
$ 200.00
GP #87599D
BB rct. 87599D
12/8/2022
Christopher Nesselroade
same
PNC Bank
1103
$ 200.00
GP #87664D
TP for JD rct. 17838
12/B/2022
Southern NC MarineLLC
HanbyFirst
Bank
1569
$ 200.00
GP #85842D
KB rct. 17891
12/8/2022
McPherson Marine Services LLC
Salisbu
First Citizens Bank
5675
$ 200.00
GP #85845D
BB rct. 18698