31542_PELLETIER, JERRY_20020322

CAMA / DREDGE & FILL
GENERAL PERMIT
New Modification Complete Reissue Partial Reissue
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
n/FG
Previous permit #
Date previous permit issued_
r `v
31,542 -e
❑ Rules attached,
Applicant Name_
j i �T p
Project Location: County_ %o, -fir- i.
Address I �i A
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_
Street Address/ State Road/ Lot #(s) -
City �'
State at ZIP 7 S8Y
_ I-7-; 04 (4,Y1
Phone # ("_`"i ) ;`t
?
I Fax # (i)
Subdivision
Authorized Agent
S�
City r{ ZIP
Affected ❑CW
@.EW
[ PTA DES - PTS
Phone # ( ) River Basin 1#0 �' {
AEC s : OEA
❑ HHF
O IH El UBA N/A
Ad Wtr. Body
. o U ww l -
I Y � � (nat /unkn)
❑ PWS:
❑ FC:
�h
ORW: yes / n>
PNA
yes / brio Crit. Hab. yes / no
Closest Mal. Wtr. Body 479�f L,< sfcV�
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 `—
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV not sure yes
no
i
Sandbags: not sure yes
no
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
no —
A building permit may be required
by:
Notes/ Special Conditions
FJ-
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit's
Application Fee(s) Check #
i
tlNlt_,
(Scale: AJONE )
See note on back regarding River Basin rules.
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Permit Officer's Signature
Issuing Date Expiration Date
Local PlanningJurisdiction Rover File Name

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 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-888ARCOAST
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
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 (nlet- and
Pender Counties)
Revised 10/C

Jere W. Pelletier NCDL 806375 9-70
Evelyn P. Pelletier NCDL 850645 ss-soissl
153 Ash St Ph 252-393-8067 s $4�$
SwambarO, NC 28584
DATE-____ - -
PAY TO THE
ORDER OF
cak (or: Micro Prin! signature hie. gray'vpe and linework. Firs' Cili>ens ftank logo on hac k. If not present do not cash. DOLLARS
FIRST CITIZENS302
7'�V7�nr Ffrst-Citizens Bank & Trust Company%�t -
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"-� — "—_ Maysville. N.C. 28555
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at�
(Lot, Block, RRoad, etc.)
on P, N.C.
(Waterbody) (Town andlor County)
He has described to me as shown bellow, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
S i anature
Print or Type Name
Telephone Number
Date:

0
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
Property located at f 7:�l /g� -�
(Lot, Block, Ro5d, etc.)
�
on ,m Z�� ��NC.
(Waterbody) (Town and/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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
S i Qnature
�-41,46,4 /- J,
S
Print or Type Name
Telephone Number
Date: