46079_NEWSOME, SAMUEL_20060708

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❑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
7 /0 l
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Previous permit #
Date previous permit issued
Applicant Name `' /}, Project Location: County
Address ( I I Street Address/ State Road/ Lot #(s)
❑ Rules attached.
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City State (�/ZIPP�
Phone # ( ) Fax # O Subdivision
Authorized Agent CityZIP °
Affected ElCW DEW ElPTA ElES ElPTS Phone # O River Basin
AEC(s) : ❑ OEA ❑ HHF ❑ IH ElUBA ❑ N/A Adj. Wtr. Body
1-1PWS: ❑FC: I (nat /man /unk
ORW: yes / no PNA yes / no Crit. Hab, yes / no
Closest Maj. Wtr. Body f
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
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
14
Agent or Applicant Printed Name 9
Signature ** Please read compliance statement
Application Fee(s)
(Scale: .A.,-, .r .a )
❑ See note on back regarding River Basin rules.
it Officer's Signature
2006 Perm
ity=Mdle sExpiratign Date
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Local Planningf urisdiction Rover File Name

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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

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ADJACEi1T RIPARIAN PROPERTY ONVI ER STATE�I��it� 7 2006
6r0A A MSJ4 U00RING PILINGoSIxoATLIfTIAOA TNOUSEj
I hereby certify that 1 own property adjacent ao-, r,� �'t� 1� .� �CM
(name of Proptrt% Ore aer)
proper;}• iocated ark �11-0�1,�___
(Lot, Black, Road, *tt.)
on .o ,ir,� -- - —'NC
(W a rbodyI (T*%vn and/or County)
tie haes described to rate, as shorn n bsto++, the de• stopment he is proposInS at thin tarition,
and, I have no objections to his proposal I understand that a pier/rrtoordns Ps9dn�o"baat�e4't!@aaathol6se
must be set back a minimum distance of fiReeat feet (;S') from rely area of riplrian access unless
Nvaived by rit,
14 do not with to waive the setback requirement
_ I" "ish to %e siN t that setback requirement.
Df SMPTION ANWOR DRAM ING OF PROPOSED DEVELOPMENT:
(To bt filled In /iudir�d,ra! pr poslut develow►rafill)
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Telephone Number'
Date /"' `
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ADJACENT RIPAJUAN PROPERTY OWNER STATENIE T
MOO A rlSA^10®JUNG JP/LIAGSIvO ,t 7'c14PTIAOA Fait
t ),*rob' eeetilj' that t waA Propofty adjasent to -'r ,8.
(Name of Propert% OrtoeQ 7 2006
Property Located at
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(Lot, Stock, Road, ate.) '`y .�nAA
on Ls , it � -- __-- _ N C.
(Nt'a rbody) (Teen and/or County)
Ns hat describod to Otte, as shoNe) batoM, the dre{optrtent he it P(OPO <nt at that Wett,on,
And. I have no objections to his propos♦ei I unders+and that a p�eNtttoorinS pi{ietje'boatlit'yDottthouse
m6st be set back a minimum distance of fifteen feet (4 s,) froth my arts of riprian access unless
waived by me.
I don wish to %vaive the setback requirement
_ 1 JU H ish to v. air a that setback requirement.
.....,..........,.,...... ... ................................... ,. ...
DESCRlPTIO` ANWOR DRAWING OF PROPOSED DEN'LLOPMENT!
(To be filled In by Individual @sing devd0prerent)
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P%tom Pnnt or Tie Dante
Telephone Number
Date