30624_PARKER, JACK_20011217

CAMA / DREDGE & FILL
GENERAL PERMIT Previous permit#
New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
GJ Rules attached.
Applicant Name .jp x_ , i J�41;.. .: _ _ Project Location: County
Address �j �� i , { i'r._ k. _ Street Address/ State Road/ Lot #(s) F c
City �.�>j State—�— ZIP
Phone # ( Fax # O
Authorized Agent Lt+1
Affected a CW C EW A ❑ ES ❑ PTS
AEC(s): ❑ OEA I HHF ❑ IH ❑ UBA ❑ N/A
7 PWS: ❑FC:
ORW: . Yes / no PNA Yes / no Crit. Hab. Yes / no
Type of Project/ Activity
Pier (dock) length_
Platform(s)
Finger pier(s)
Groin length -
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length _ _-
SAM not sure yes no
Subdivision
City ZIP
,—
Phone #
(- ) ,2=; -t:�>;;� � , River Basin
Adj. Wtr. Body fnat /man unkn
Closest Maj. Wtr. Body
(Scale: )
Sandbags: not sure yes no {
Moratorium: n/a yes no'- c
Photos: yes no Alp
Waiver Attached: yes no ---- — ---
A building permit may be required by: See note on back regarding River Basin rules.
Notes/ Special Conditions
i
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
t
Application Fee(s) Check #
Permit Officers Signature
Issuing Date j Expiration Date
j
Local Planning Jurisdiction Rover File Name

ON
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 Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-888-4RCOAST
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza If
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 10/C

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ADJACENT RIPARLUN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUS%',__,,_?
I hereby certify that I own property adjacent to J_ 's
(N e of Pro rty Owner)
property located at
(Lot. &Cock, Road, etc.)
C4u'_
on -� in �� �r , N.C.
(Waterbody) (Town nd/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boathft/boathouse must be se: back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me. l
I do not wish to waive the setback requirement.
�- I d_4 wish to waive t;.at setback requirement.
DESCRIPTION AN_D/OR
(To be filled in
RAWr G OF PROPOSED DEVELOPNfEN-T:
K individual proposing development)
\- �— E-=_�'
3c'
S[Enature
Ha v-h v r A l e. e S
Print or Type Name
Telephone Number
Date:
I

' ADJACENT R.IP'ARL-�N PROPERTY OWNER STATENIE"N
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 1,—"L 's
e of Prope Owner)
property located at 1.3,E � ,
(Ildt, Block, Road, etc.)
on in A ,
N.C.
(Waterbody) (Town a d/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
piiings/boatlift/boathouse must be se: back a minimum distance of fifte--n feat (15') from my area
of riparian access unless waived by me.
I do not wish to wai,,-e the setback requirement.
DEC 14 2001
I Q wish to waive tr.at setback rec.iirement. __ J
COASTAL MANAGEMENT i
DESCRIPTION AND/OR RAWr G OF PROPOSED DEVELOPNIE`-I':
(To be filled in b individual
d vidual proposing development)
o -(
I � I
I y �
�o
Signature
C V
Print or Type ame
L - 4
jTelephone Number
Date: — >