43575_MOLET, JOE_20051213

1
❑ CAMS► / ! DREDGE & FILL6�
GENE L PERMIT -61 �aju�' f`
Previous permit # �
,CNew ❑Modification L1Complete Reissue ❑Partial Reissue Date previous permit issu d
As authorized by the State of North Carolina, Department of Environment and Natural Resources j
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name �)6—* t,'tftl 16— { Project Location: County __
Address- Street Address/ State Road/ Lot #(s)
City Ve-t", Oei .) State ZIP
Phone # ( ) ` Fax # ( ) Subdivision - j • c: '� « ��1 Get'`
Authorized Agent �. r�,^� ; _ / r. r'--r. , City /`7�' r A-J ZIP_
- CW
❑ EW � PTA
Affected
A -i OEA
ElHHF ElIH
C', PWS:
❑FC:
ORW: yes / no
PNA 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
❑ES ❑PTS Phone # ( ) ? �'! 2� River Basin
❑ UBA ❑ N/A
Adj. Wtr. Body - nat man /unkn)
Crit. Hab. yes / no Closest Maj. Wtr. Body _
I : OL,- (Scale:
Agent bunt rinted Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
/ .K,1
Local Planningf urisdiction Rover File Name
E

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 �J 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 (910-796-7215) for more information on how to comply with these buffer 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
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
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

A'UG-03-2005 WED 01:46 PM NC DIV OF COASTAL MGMNT FAX NO. 4 P. 02
AID, ACJ;,N I' Rrl'ARAN PROPERTY OtiWFM STATI-,NI �i``f'1'
(FORA PIEk/+iMORING PILINGS/80A7LIF7-/nOAT1I0USE,)
I hereby certify that I own property adjacent
(Namc of Property Owner)
l�ro��rty loc;ttcil at �G�� �=>T�2aU
(I,u(, Mock, Road, etc.) -_--_
on A"Cie— �4n/A C _ i n %l C,v � �Q
- --- N.C,
(Nt';;terbody) (Town and/or County)
IIe h,ss d scrilxd to wo, as shown bolow, the development lie is proposing at that location,
and, I have no objectio+is to his proposal. I understand that a pier/mooring
l�ifings/U��ltliftlt�+nihous: must be s<:t lack a minimum distance- of ftFteen Ftcc (15') from my arc1
of tipanan acccs� unless waived by mk�.
1 J()_uj21 wish to wnivo tiro sl'thZck redL+ireir%!nt.
t (ir, `41�11 t7 �b1tvL th,'a s,,,back rc:qulr;:ment
. ---------------------------------------
nr sc lzlrrl��� ,�Nn;ot: DRAWING Of` PROPOSED Dr-,NT .OPtiI1;N1:
(To be filled in by individual proposirrc., developmeirr)
/It
r
N
LO,7zn/*
Print or Type Name
Tetephone Number
Date: ��

I hereby certify that I own property adac.-it to 4- - M o ( e`1 - ,s
(Name of Property Omer)
propmV located at / 0 ao a - rn ft,« Se c- . J`7 0Ar/ 2 / yea ua2 C� ✓ e- vu 1 S'k w CI)
(Lat. Block, Road,an e u f , in 2LJ e.2 ►�zekA Ue �1 v,� , N- C_
(Waterbody) . (Town andfor County)
He has descn-bed to me, as shown below, the development he is proposing ar thar Iocation,
and, I have no objections to his proposal_ I understand that a piermooring
pain-/boaddi Uboathouse must be se: back a minimum distance of fifte= fleet (Ili') from my a -
of rip— a access unless waived by me:
I do not wish to waive the setback recuirement
I da wish to waive &at setack requirement
DE5CRIP'IT0N AND/OR DRAWr. iG OF PROPOSED DEVELOENE T:
(Tv be filled in by individual propoazn; development)
Co ti S-©P nn �
jj �T Woad J),�L ►u ce�,�r a-t-
S h o re
w g
U
Signature
Print or Type Name-
. .GiG :tea ,> -Cs77
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