47214_PETERSON, LAWRANCE_20060829

0 CAMA E'DREDGE & FILL
GENERAL PERMIT Previous permit #
LI-New ' ElModification ElComplete Reissue EJPartial 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 e State 'J ZIP
Phone #( Fax # —') Subdivision
ZIP
Authorized Agent City_
11
El CW DEW D-PTA ❑ ES ❑ PTS Phone# O River Basin
Affected
AEC(s): [_1 OEA Ll ❑HHF [:] 11H 0 UBA 7 N/A Adj. Wtr. Body (naf /man':hAnkn)
1-1 PWS: El FC:
ORW: yes / no IPNA yes / no Crit. Hab. yes no Closest Maj. Wtr. Body
Ty e of Project/ Activity
(Scale:
7-7
Pier (dock) length f "'J
Platform(s) t
Finger pier(s)
Groin length
number
Bulkhead/ Riprap, length i
avg distance offshore
r
max distance offshore
Basin, channel
cubic yards
Boat ram
7 Boathouse/ Boatlift_"' �/-
Beach Bulldozing
Other
Shoreline Length
il
SAM not sure yes , �n0
Sandbags: not sure yes 00
Moratorium: n/a yes no
Photos: yes,_ Cno —i—
Waiver Attached: yes) no
A building permit may be required by:
Notes/ Special Conditions
FM
UNN
21 1- NINE
����, Jam' � '�---i
1 1 L
L'See note on back regarding River Basin rules.
V
()Y`
Agent or Applicant Printed_. �Ja Permit Officer's Signature
Signature Please read compliance statement on back of permit Issuing Date
Application Fee(s) Check # Local Planning Jurisdiction
Expiration Date
b,:f 9 i
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 [)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 ❑ Other:
[euse 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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

LAWRENCE W. PETERSON 8242
TRACY L. PETERSON
400 RAGAN RD. PH, 252-249-2561 Q 87-156/642
ORIENTAL, NC 28571 2 20-0-6 001913220
N� / v
Pay To The 06
_,
Order Of �
p,
Y �C, u•'✓I ���C�C JyV DOLLARSIJ
FIRST
,TENNESSEE
FOR CHECK VERIFICATION DIAL I-Qpp26d-0130C�l
Memo— rn v
1:061�560j:8 2', 2 0049, Oii'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATIIOUSE) 76.1 9 7S
y5z - zV 9 - 2,!�'6 i
I hereby certify that I own property adjacent to Ljza;1Vcfi0 a l r'Cv 4)PL1eVA 's
(Name of Property Owner)
property located at l o fi 1 � lg! o� JG -S eA V`r s,oi a Jc� tt ` � "'fie
(Street Address, Lot, Block, Road, etc.)
on �14k� 1 Lh lfklt 2 e I , in CI J� J �C'( I f & Vh It (- n 7 N.C.
(Waterbody) (Town and/or County) I -
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 understapd ,that -a
pilings/boatlifdboathouse must be set back a minimum distance of fifteene
access unless waived b me. I have indicated my intentions by ii'y g elow:
riparian y
JUL 2 8 2006
I do not agree to waive the 15' setback requirement.
t I do agree to waive the 15' setback requirement. m O re h e ad City D C M
itials)
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
ature
Print or Type Name
Z4 y - ) `/ �'9
Telephone Number
Date: ' 7 �-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATIIOUSE) ` Cell -70
� 5 2 z y,*z s� iF 7�' eii d
hereby certify that I own property adjacent to '--Awrer iu--. f I etc y
(Name of Property Owner)
property located at Lo i 14 6IaLC $i Sc',s,l,�s;� 5�abd��D►'����T.ttc',���sr `A LLMY-1
(Street Address, Lot, Block, Road, etc.)
on , ti 1j ' in O ' e11 V7* t _ �1vr, L, C-C, , N.C.
(Waterbody) (Town and/or County) Z 0 `> -7
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 ,
riparian access unless waived by me. I have indicated my intentions by i
I do not agree to waive the 15' setback requirement. JUL 2 8 2006
I do agree to waive the 15' setback requirement. MQrghead City DCM
(initials)
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Signature
Print or Type Name
Telephon Number - �Z � -4`,r 2-01 a
Date:

ADJACENT RIPARIAN PROPERTYONW\TER ST'ATETMENT
I hereby certify that I own property 2djacent to Lawye-nce 4-��` pefe+=�'tj '`-
(�'ame of Property Owner)
ro e t located `t t jpi,��c pc �� Sig V'�5 + b�l►� b 2F�n ;,�� H�1� � Jots fze+ AN �cl * L, NK-
P "`}
(Lot, Block, Road, etc.)
N.C.
on-1�!-P.�.�c-.,tii Lhf� IvN �. , i<< � o� er►T�L 1�� �r.i_► Lt:t ,
(Waterbody) ?f" 1
(Town' and/or County)� •,�—�,,
e ti shown below, the development he is propo scG��j1 �t`iocat
He has described t� m
and, I have no objections to his proposal. JUL 2 8 2006
Morwip-arm DCM
DESCRIPTION ANTDIOR DRAWING OF PROPOSED DEVELOPiAIENT
(To be filled in by indit,idual proposir.,; development)
�cn2ture
Print o:
TelNumber
Date: 252 ?-dl-�j 2-D 1 '2-
-29—

ADJACENT RIPARIAN PROPERTY OM\TR STATEMENT
I hereby certify that I oNvn property adjacent to LZAwre-Act 4-�� y pe-fe-ez�t-' 'S
(Fame of Property Owner)
propert • located at j ,- i-{+ �i.�u 4 � SG�► t'�� S+ibcl►� b 2wn i+'y- Hej4r�� fgov fzAQAtJact *LFN�-
(Lot, Block, Road, etc.)
on 1AgP C 4A-OV'IVC- L- , ir'„ 0fZ►e-r,Tt_ P-Arn"- ) , N.C.
(Waterbody) (Town and/or County) I� Up
laotitn belo,� the develo Went he is proposi at location,
He has described to m., ass P
and, I have no objections to his proposal.
JUL 2 8 2006
Morehead City DCM
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVE rLOPMENT
(To befilled in by individual proposing development)
L C Iq t TAt- 11 Cb De-A-w',Aq
SiL/ni"Ure
—Jb��,Ly;;N
Print o: Type Namc
Telepho:ic N'Jmber
Date: �z
—29—

777
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