30606_ROSE, EDWIN T_20020130

"NCAMA / D DREDGE & FILL
GENERAL PERMIT
Previous permit #
FLINew ❑Modification El 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
[11 Rules attached.
Applicant Name _ Project Location: County
Address_j _ Street Address/ State Road/ Lot #(s)
City
_ _ State _ ZIP_
Phone # ()
Fax # ( )
Authorized Agent
_
❑ CW
❑ EW PTA ❑ ES C PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH r UBA ❑ N/A
❑ 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 _
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
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit"
Subdivision
City ZIP_
Phone # ( ) River Basin
Adj. Wtr. Body__ (nat /man /unkn)
Closest Maj. Wtr. Body
Permit Officer's Signature
Issuing Date
(Scale: )
Expiration Date
1
Application Fee(s)
Check# 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, 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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 Inlet- and
Pender Counties)
Revised 10/C

31
It It >I f
� rY .. yd,.a.
7 .�Y .;►
7fY>!a
>(y IS >I >t a1 >>d F p'sd (f
•( E.
' A IV- d'j 1 yid

Fr ,m:
P01
01/29/2002 16:1-9 252-816-5394
P4JHC1L0,'5r' DEPT PACE 01 f 01
JD 191934614396 POI
From
ADJACENT Rl[PARIAN. PROPERTY O`iNER STATEMENT
(FOR A NEXIHOORING PIMP GS/BOATZJFT1B0ATHOUSE)
c.
that I own propeflY a<jjac�t to
I hereby Qgame of Pruperty Owner)
propdcty IOCaiLd S$ _ Black, Bey etc-)
atoebody) (Town and/or County)
He has dcsalbed to Par, as.shown below, the daveloptnent he is proposing at that
loatdoo, � I have no objections t0 his Draposal. I uaderstaad that a pierlmooar a
�gy'b �l OWAOuso must be s* bank a minimum distance of fifteen fat (15') from my area
of Agsdo acoeas unleso gvalved by mo-
I wish u) waive the 9$tbaok requirem3nt.
I
I IQ wish to waive that setback rcquirotnent-
.._..-._.._..--
DESCRIPTION AtMiOR DRAWING OF PROPOSED P EM :
cro bey f hied In by inavi4d PmPa g
Siguatnre
cl� a* f t 5 F- 1
Print or Type Name
�ele�phon�Number
Date: [X� a=-
r.
�� „ ?/(.) ') �,v4, q 3q,,l

From' JA 1919346-429F, F101
ADJACENT RIPARIAN PROPERTY OWNER STATEN'ENT
(FOR A PIMMOORING PILINGS/BOATT IMBOATHOUS )
T that T num nrnnPrty adiaG@nt to
� � .(Name of Property OWner)
L V T
property Iocated at _ 0
(Lot, Block, Road, etc.)
on� k C.. J.o. 1 in (./ h-) SL v t� N.C.
(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. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (13') from my area
of riparian access unless waived by me_
I do not wish to waive the setback requirement.
ti
I dg wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled to by individual proposfng development)
s` l
lei
Print or Type Name
1910) 6 --,-2
Telephone Number
Date:
A\
W