45156_NAJORLAN, GEORGE_20060406

❑ 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
-Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( ) Fax # ( ) Subdivision
Authorized Agent City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): [IOEA ElHHF ElIH ❑ UBA N/A Adj. Wtr. Body (nat.'/man /unkn)
❑ Pws: ❑ Fc:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s)
Finger pier(s) l
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore'- 1
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 APR 1 ] 2006
it Officer's Signa
44- o 4
"See note on back regarding River Basin rules.
Signature Please read compliance state"on bac of permit Issuing Date
morehgad ity [)CM ,•�, e:.
Application Fee(s) Check # Local PlanningJurisdiction
Expiration ate
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 (252-946-648 I) 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 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:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
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/ 1-888ARCOAST
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOU�S�E) -
e
hereby certify that I own property adjacent to eg bla' a 's
property located at
(Name of Property Owner)
(Street Address, Lot, Block, Road, etc.)
on /lQ ciin �w > N.C.
(Waterbody) (Town and/or County)
He/she has described to me, as shown below, the development he/she is proposing at that
location and I have no objections. to .this proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area of
riparian access unless waived by me. I have indicated my intentions by initialing below:
I do not agree to waive the 15' setback requirement.
(inif
I do agree to waive the 15' setback requirement.
(initials)
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
----------------------------------------------- ------
Y.x" � � �i --�L - -,_ ,
Signature
/- n;ryX1Z k--) P-3- f�lZ� Jit
Print or Type Name
qIy - 4 5 -5344,
Telephone Number
Date: Fe—k4 16) 20 6

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to �,e- 40' ,,ea 4y /Ag��s
(Name of Property Owner)
property located at
(Street Address, Lot, Block, Road, etc.)
on 9S(-1eP<— in (Gc ;ce a!,, N.C.
v
(Waterbody) (Town and/or County)
He/she has described to me, as shown below, the development he/she is proposing at that
location and I have no objections to .this proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area of
riparian access unless waived by me. I have indicated my intentions by initialing below:
I do not agree to waive the 15' setback requirement.
(initials)
�
&, I do agree to waive the 15' setback requirement.
(initials)
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
N
Si nature
Print or Type Name 77
Telephone Number
Date:J6 ` 6

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FOR
.........
. ............ ..
. . ............ .....
RONNIE CHADWICK
CHADWICK CONSTRUCTION COMPANY 10468
524 CEDAR RIDGE DR
WINTERVILLE, NC 28590
252-728-4504 66-112/531
PAY
TO THE
ORDER OFL,� e.
BRANCHHH&T
I-,M",',G.;�O.T%S,,TTC�OMI'ANY
(f14-;7,j14 � , V �
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02302
DATE
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