45773_NORD, MICHAEL_20060615

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❑CAMA / ❑ DREDGE &FILL
GENERAL PERMIT Previous per t#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous pe mit 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
Phone # (i)_
Authorized Agent
Affected ❑ Cw
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
,•r
State ZIP
Fax # ( )
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
PNA yes / no. Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length S A i '
Platf
Fing
Groin
Bulk
Basir
Boat
Boat
Beac
Oth(
Shor
SAM
Sand
Mor
Phot
Waiv
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body gnat ./man /unkn)
Closest Maj. Wtr. Body
(Scale: )
orm(s) 1
er pier(s) j
length
number
lead/ Riprap length
avg distance offshore _
max distance offshore
channel
cubic yards
ramp -
louse/ Boatlift a
I s I
Bulldozing
r
eline Length
not sure yes ono
'•
bags: not sure yes ino
atorium: n/a yes no
os: yes no
er Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
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Signature Please read compliance
See note on back regarding River Basin rules.
Permit Officer's Signature
CMIssuing Date
Expiration Date
Application Fee(s)
Local PlanningJurisdiction
Rover File Name
A building permit may be required by:
Notes/ Special Conditions
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Signature Please read compliance
See note on back regarding River Basin rules.
Permit Officer's Signature
CMIssuing Date
Expiration Date
Application Fee(s)
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
Iandowner(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 11 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 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

ADJACENT RIPARIAN PROPERTY.' O� NER STATE?�IENT
I hereby certify' that I own property adjacent to
(Vane of PropWy Owner)
pro�xr--Ly located at
k/
(Lot, B1oc1;,'Road, etc,)
on _
in �i�.� �0 N.C•
Va �aterbody) (T itin end/or County)
He has described to me as shown belo,,v, the development he -is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION ANTD/OR DRAWING OF PROPOSED DENTLOPIMENT
(To be filled in by indii,idual proposing development)
Signature
Print o. Type NZn"
Telepho,-te I�Tunber
Date: - L/ —
—29—

UNITED STATES POSTAL SERVICE
PIEDMONT TRIAD A R-1 k
Permit No. G-10
• Sender: Please prin your name, addles zi
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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Deliver, is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
L, t3I�LL-lwP
0, yJ
Z7 �t
A. Signature
X ❑ Agent
_ ❑ Addressee
B.y�Rleceeived by ( Printed Name) C. Date -of Delivery
�
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 1160 0007 5106 5122
(Transfer from service label)
PS Form 3811, August 2001 Domestic Return Receipt
102595-02-M-1035

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Ph 252-249 IR8 9' COIVSZRU
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DATE
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