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NERAL PERMIT
As authorized by the State of North Carolina, Depanment of Environmental Quality
and the Coastal
Applicant Nam
Address
ntal concern pursuant to l5A NCAC
N9 76631 C D
Previous permit #
Date previous permit issued_
/0o
E
B
Resou Commission
e a./'l
in an-area ofenvironme
[(euJ1;".,Project Location: County C,
Street Address/ State #G)T"; Dr)
ciry-5t+c c,/0lv t
flwEl-1@,n
ztPeiDlt)d11-
Phone #Subd
City
ivisaon a*;tr="-zlP cAuthorized Agent
cw
Affected
AEC(s): oEA
P}YS
& zna --g6 trPrs
JHHF 'IH
f UBA trtVA
*","*,G76^
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Adi. Wtr. Body
Closest Maj. Wtr. Body
tuL-man kn
ORW: yes PNA ,/* d
co or(-Cal,?r.--
7
Type of Proiect/ Activity
,/'Y/rr )
-i--T---]Pier (do<k) len$h
Fixed Plat orm(s)
Floating Platform(s)\-/rV
Finter pie(s)
max distance ofilhore
Basin, channel
Bulkh€ad/ Ripr.p len$h _
av8 distance ofrshore
cubic fards_
Boad ramp _
Eoathousd Boadlft
Groin hngth
number
Beach BulldozinS
Other
Shoreline L.rydr
-SAV: not aune
Moratorium: rva
Photoc:
Notes/
yes Glyu (fi,*c
/)t,ro L,
A buildinS permit may be required by:
( Note Local Planning Jurisdiction)
. See note on bac.l reSardinS River Basin rules.
{u.-" ct' kd? ?a-ll(<L,-l /ct^C
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Caq,c
ffrtiti[
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Agent or Applicant Printed Name PermitOffi
ssread compliance statement on back of
Check#lss
az.J
E
LrModification []CompleteReissue flPartialReissue
Phone # (-)-
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Statement of Compliance and Consistency
This Permit is subiect to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may sublect the permittee to a fine or criminal or civil action; and may cause the permit to become
nulland void.
This permit must be on the proiect site and accessible to the permit oflicer when the proiect is inspected for compliance. The
applicant certilies 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 adiacent riparian
landowner(s) .
The State of Nonh Carolina and the Division of Coastal Management, in issuing this permit under the best ayailable
information and beliel certify that this proiect is consistentwith the North CarolinaCoastal Management Program.
River Basin RulesApplicable To Your Proiect:
Tar - Pamlico River Basin Euffer Rules
I Neuse River Basin Buffer Rules
lf indicated on front of permit, your project is subiect 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 Otfice (252-946-6481) or the
Wilmington RegionalOffice (910-796-7215) for more information on how to complywith these bufferrules.
Division of Coastal Management Of,ices
Morehead City Headquarterc
40O Commerce Ave
Morehead Ciq/, NC 28557
252-808-2808/ r -888-4RCOAST
Fax: 252-247-3330
(Sewes: Caneret, Craven, Onslow -
Nonh of New River lnlet- and Pamlico
Courdes)
Elizabeth City District
401 S. Griflin St.
Ste. 300
Elizab€th City, NC 27909
252-264-3901
Fax:'252-2&4-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gate.s, Pasquoank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-648t
Fzx:257-948-04.78
(Serves: Beaufort, Beftie, Hertford, Hyde,
I/rrell and WashinSton Counties)
Wilmin$on District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal.ncdenr.orglweb/cm/dcm-home
Revised 7/06/ I 7
f o.t"r-
CERTIFIED MAIL .RETURN RECEIPT REOUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERW OWNER NOTIFICATION/WAIVER FORM
Name of Proporty O,vne,:A
Addrass of Property:I lvrl h,re\oO Sac.bJ,o^,-I)r-NL Z&Sla
(Lot or Sreet #, Street or Road,City & CountY)
Agent's Name #:
Agent's phone #:
MailingAddross:
fi you htye ob)ccdo/l, to whrtlt bahg ptpposod, you fiutt now tho Dlvtrlon ol Co.sbl Uan.ga,nonl (DCrl) h
trrldng *fihln l0 d.ls ol .rc.lpl ol thlt nodca. Conetqondaoc.shoatd ba ma .d to 12f Ctdln.l Odv. Exl,
Wlmlngtoo,NC, 28/1,'.3E15. DCll rap,rten,fues can .bo b. cont clad .t (91 0)79Gf215. ,lo rcspon o,t
con-tldand the am. aa no oblecdon wl)hrv6 baen notlllod by Cedillad Ma .
WATVER SECTION
I understand that a pi€r, dock, mooring pilings, breakwator, boathouse, lifl, or g
back s minimum distance of l5'from my araa of riparian accass unlass waivod
wish to waiva thg sslback, you l4ggllEElglfie sppropriate blank below.)
_ I do wish to wsive the 15'setback tequirement.
c 9t.I do not wish to wsiv6 ths l5'selback requirement.
(Ptops
-)eat lJat",tr'"'l
Signanre
(u0,,,. il 11,1,J",
"('ilT"Ko-7n^, htoL
cant P or lntormatlon)
Mailing Address
f*t r.,"r,l 1,. Nc Lgtlo
CWStdte/Zip
fio'?jl - 7?v{
,Telephone Nunber
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Prinl ot fW Nane
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Mailing Addrass
CMStatoaip
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Qo4-931 -b'e7
Tdlephone Numbar
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Date Dole
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I hereby cartify thst I own property adjac€nt to the abova rofelenc€d property The indivldual
apptyin! tor rrii permit tras ieicriolJ to ma as shown on the attach6d dtswing-tho d6v€lopmont
ttieyirJ proposing. A doscrlolion or drawino. wlth dimenslons. must be orovided with thls lettor.
/ {L- ruuo" oo objections to this proposal.
-
I have objcctions to this ProPosal', ,
r ma. (lf you
t/
j Rofied AlW012
CERTIFIED MAIL .RETURN RECEIPT REOUESTEO
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERW OWNER NOTIFICATIONMAIVER FORM
Name of Property O,rrnen
Address of Property:
tn
cIo.. Blrt
(Lot or Street *, Street or Road, City & Coun tv)
1l&,".'l t, uc zB5{o
Meiling Addr6ss:
I hereby certiff thst I own proparty adjacent to the abova referencod property The indivldual
,pprv,nri ro, r',--i" p"-it 1r* i"t:*iulJi,i.a 8s shown on lhe attachod drawing-tho development
ttidyiripipo"i,ig. A d -crt- ti- --dr'.n , th d'mengtons. must be orov'ded w'h th's letter.
M 0 tr t f^o. no objections to this proposal.
-
I have objections 1o this proposal'
tf you h.v. obl.cdons lo wrtrt ls bcln, pmposod, you fiusa now Ao OlYlston ol Cossat Man'ge'ncn' (DCH) in
witUng wfdtd tO 6.ts ot ncapt ot 6L a6tco. iornspoadenie should be n.ll.d lo 127 C.dlnel Ddvc Ext,
w[n6gton, NC,2EZo5-3815. 'oalt nftrf,t.natlvcs cin elso be cont cts/d st (910) 79&7215. No rcsqonso ls
coflsldend lhe ,nna ts no oblecdon wu hava beao not led bv Cotdllad Mall.
WAIVER SECTION
I undorstend that a pier, dock, mooring pilings, br6ahflat6r, boalhouse, lifi, or groin must ba set
back a mlnimum distance of 15' from my area of riparian accels unl63s waived by me. (lf you
wish to walv6 th€ seback, you @LEU3! thg appropriato b'ank below.)
M 0t\I do wish to walv6 the 15'sEhack roquirement.
-
I do not wish to waivg the 15'setback requirement.
Pro n)(Adlacent Proporty Ownsr lnformatlon)
O'N*..
Signature
ML(aaqy Or\oruur;cr
Plnt ot TW€ Name
vo lo EAsT Bg :lsuoo( Bf u 5
Mailing Address
Nc 28540 TEc ksop u,l l(
City/StdteEip
A&f4o
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Plnt ot TW Nane
8 t Bxfftrnt 0,
Mailing Addross
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Tolgphone Number
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Revised A1V20t2
Date
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AgenFs Nama #: __
Agent's phohe #:
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NC Division ol Coastal Management
Cashier's Official ReceiPt
11837 ^{OD
,o@Oate:
$o
Check No.:
County:
Date:
Date:
(
t-{,I q
Permit No.:
Applicant's Name:
Project Address:
Signature of Agent or APPlicant:
Signature ol Field Representative:
Please retain receipt lor your rocods as proof of paymgnt tor pormit issued'
)a
q qReceived From:t