40269_NC DOT_20050128

❑CAMA % LJ DKEDGE & FILL
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GENERAL PERMIT
.
Previous permit #
tNew L'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.
-7
Applicant Name (� (
Project Location: County
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Address_ l�� ,� k i�f � f�Cl> UI Y
-
Street Address/ State Road/ Lot #(s)- Jr
City_ State ZIP
) ;tt (tC
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Phone # !' fi
O �= l''y � � Fax # O
Subdivision
Authorized Agent f\t C �, wt tiS I (,W
City
- ZIP-
Affected ❑ CW q1W ❑ PTA )�S ❑PTS
Phone # ( )
River Basin = tJL'}-�;!j r�
El ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body �� ✓ : /{/- "L!� �, .;'i
..
-- (nat
El PWS: ❑ FC:
-IfClosest
E(m)/unkn)
3
ORW: yes / no PNA yes J no Crit. Hab. yes / no
Maj. Wtr. Body
Type of Project/ Activity
;.• /j
f
t
II
'
(Scale:
Pier (dock) length
I
Platform(s)I,A;t
Finger pier(s)
Groin length
number
Bulkhead) Riprap length K
avg distance offshore
max distance offshore J Cr u+
Basin, channel - �--� -u _ z•--- —
cubic yards (1 t� (,-k AA L
Boat ramp
Boathouse/Boatlift
Beach Bulldozing f r_—' _ _ I 1 i� IftT - ---� ' liUf t! (^_P1N L
Other c�T
�1Jtv'1rr l:fC r,� psi -#—w-Y,` lrtt�
Shoreline Length
SAV: not sure yes no _ - _--����
Sandbags: not sure yes no - l kAx C
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes rio: - . --- 't
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A building permit may be required by: ; _if tdlr)(dJ oi 7 , I , ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions J({ fr L ( �' t rt Li ►�� 1�1�!{ �S a11� f M tSYt DGl 2 1 ��"' f'(. tit' !1^ `.1 1"�L P-' '�i �C
S ti tti nl I:N DIL jkvtAi i ISSN 4b i Tz A,YiI(I,A& rf Nlca
ltlllU l iv',1 1�( ,1:flf.ti I �,+L✓1f E v/t iit ':O, hAjr IS Clv)A i-to)
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Daie Expiration Dke
Local Planning Jurisdiction' ! 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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules 1 Other:
7 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)
www.nccoastalmanagement.net
Revised 10/05/01

Shoal
Dint
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ADJACENT RIPARIAN LANDOWNER STATEMENT
( Dare County: US 264 )
am an adjacent riparian property owner and am
aware of the No h Carolina Department of Transportation's plans for the pipe
replacements on US 264. 1 am further aware that this work will occur in an AEC and
therefore will require authorization from the Division of Coastal Management in
accordance with the Coastal Area Management Act (CAMA).
I have no objection to the project as presently proposed and hereby waive
th t right of objection as provided in General Statute 113-229.
are attached.
I have objections to the project as presently proposed and my comments
ro '
Signature of Adjac t Landowner
Date: