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As authorized by the State of Nofth Carolina, Department of Environmental Quality
14o*o r/oaeoce tettt
GENERAL PERMIT
-lNew -Modification -Complete Reissue lPartial Reissue
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aL
N9 76629 AB c D
Previous permit #
Date previous permit issued
attached
G)
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River n
20uand the Coastal Resou
Applicant Name
missron rn an of environmental concern pursuirnt to l5A NCAC
\(f/Pro,ect Location: Countyo,(Street Address/ State
State zlP
ail Subdivision
City_
Adj. Wtr. Body
PNA yes no Closest Maj. Wtr. Body
Cit),
Phone #
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AEC(s): :loEA llHHF LllH
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Phone # ( )
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Type of Proiecv ActiYity (Y.'r)
Jt-e:)
Pier (dock) length
Fixed Platform(s)I a
"-T ;t fi#Finger pier(s
Groin length 3Ii i]
i .lr
L r-L,-i
T_T ,, ,." lpl
Bulkheld/ Riprap len8th
\r'rr r'1, I t
av8 distance offshore
max distance ollshore
Basin. channel
1_? _t:ot t11 -/-
cubic yards
Boat ramp -_r__T l
Beach Bulldozing
Other -teaR
.l.' -1.---]--_H l,-]ffi
SAV| not sure
l.loratorium:
^la
Photos:
]
yes {ttl
A building permit may required by w\et fl s.. not"
--lt^
on back regarding Rr-ver Basin rules.
u'17"/
( Note Local PlanninS Jurisdiction)
Agent or Applicant Printed Name
Pe rmit**Signatu** Please read compl
DFee(s)
iance statement on back of
Check#lssui
P
e
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Expi
t)
Address L1
Authorized Agent
LES :] PTS
] UBA ] N/A
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FloatinS Platform(s)
Shoreline Length
Notes/ Special Conditions
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Satement 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 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 proiect site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that l) prior to undenaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this proiect 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, certirythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin RulesApplicable To Your Proiect:
E Tar- PamlicoRiver Basin Buffer Rules
! Neuse River Basin Buffer Rules
lf 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 fuver Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Olfice (252-946-6481) or the
Wilmington RegionalOffice (9 l0-796-7215) for more information on howto complywith these buffer rules.
Diyision of Coastal Management Oflices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I -888-4RCOAST
Fax: 252-247-3330
(Serves: Caneret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Grilfin St.
Ste. 300
Elizabeth City, NC 27909
252-264-390t
Fax: 252-264-3773
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax:252-948-M78
(Serves: Beaufort, Benie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
9t0-796-72t5
Fax: 9 I 0-395-3964
(Serves: grunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
hft p://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ I 7
othe.r-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certifo that I own property adjacent to Chris{opher Harris
(N
property located at "J oo$)-1,. l-At lq.-
ame of Property Owner)
o
on
(Addrcss '*L":1il Road, etc.)
,Nrn
(Waterbody)(City/Town and/or County)
icant has described to me, as sho^/n below, the development proposed at the above
I have no objection to this proposal
I have objections to this proposal.
5
The appl
tocayfi.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPM ENT
r)
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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. (lf 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.
(Pro (Adj acent Pro perty Owner lnformation)
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Date
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(Revised Aug. 2014)
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mo. 1tt you wilr o u,Orr $a !rabac*, yu,, mr.t lnHd tho lppropriatg blslk bdo'w )
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I 6 wfi to rdE ntr6 15 astbsct lrqtufi€t{.
not wiEh b lvaive th€ 15 setb€ck Bquirem€nt
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n/6&l6rm. ^el'd* r..t at&.|^a.lir."
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