45271_RENFROW, MARION_20060511

GAMA / ❑ 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 I SA NCAC
❑ Rules attached.
Applicant Name / AA1 i 0"I I\P^ f %y v Project Location: County C /✓
Address U`
/ f � � � 7r, 11 � Street Address/ State Road/ Lot #(s)
City NJ W i !1 �� State
` ZIP ��c�� L,✓,/-e (/
Phone # (!��'-) 2� j'" Sas ( Fax # ( ) Subdivision
Authorized Agent
Affected ❑ CW O.EW ❑ PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Platf
Finge
Groin
Bulk
Basin
Boat
Boat
Beac
Othe
Shor
SAV:
Sand
Mor
Phot
WaiN
City / e IVO/ ZIP
❑ ES ❑ PTS Phone # O River Basin
❑ USA ❑ N/A
Adj. Wtr. Body _ i' ' (nit /map?/unkn)
Crit. Hab. yes / no
Closest Maj. Wtr. Body
(Scale: Al -I ( )
o
Crm(s)
r pier(s)
length - -
number 7
_II i I
head/ Riprap length -- —�-�
avg distance offshore
max distance offshore
/
channel � ..
- - -- s
I
cubic yards 6-10
P
ram -- _
t - ❑—
I
house/ Boatlift
17
I II
h BulldozingI
I
r
I
Mine Length I -
not sure yes no: i
I I i
)ags: not sure yes no -
- �—
torium: n/a yes no — -- —
I i
>s: yes nd
i
Br Attached: yes ,no/ J--- -
A building permit may be required by: C U ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions (p/ e - GQ ,
cam=/`, '�-•,, � -
Ag/enitorApplicant Prirkee{drName' Permitowider'sSignature
/
IL A
Signature Please read compliance statementiWAIRAINad City DGWate , Exp ration Date
Application Fee(s) Check # Local Planningjurisdiction Rover File Name
A building permit may be required by: C U ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions (p/ e - GQ ,
cam=/`, '�-•,, � -
Ag/enitorApplicant Prirkee{drName' Permitowider'sSignature
/
IL A
Signature Please read compliance statementiWAIRAINad City DGWate , Exp ration Date
Application Fee(s) Check # 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
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:
L _ Tar - Pamlico River Basin Buffer Rules FJ Other:
j 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
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, INC 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 PILINGS/BOAIFT/BOATHOUSE) I hereby certify that I own pi peaty adjacent to 's
(Name of Property Owner)
property located at
(Street Address, Lot, Block, Road, etc.)
on , in A— , N.C.
(Waterbody) (Town and/or Coun
I-Ie/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'a ree to waive the 15' setback requirement.
g q
(initials)
I do agree to waive the 15' setback requirement. �AAY zaps
(initials)
-------------------------------------------------------------------- ----- .-- - -------------------
DESCRIPTION AND/OR DRAWING OF PROPOSE +
(To be filled in by individual proposing development)
6-
oyq�
I-, iN14J/
Signature
_R� e 1` 1-4icr
Print or Type Name
Telephone Number
Date: I ( Al A Y —14A�56

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILI_NGSIBOATLIFT/BOATHOUSE)
hereby certify that I own property adjacent to l c,f _'s
property located at
(Name of Property Owner)
��jj FF J
(Street Address, Lot, Block, Road, etc.)
on , in �� , 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 intentio b laW_' _
.I do not agree to waive the 15' setback requireme% b/
(initi Is) MAY 1-1 1.ou
_ I do agree to waive the 15' setback requirement.
-_ itials)
-------------------------------------------------------------------- -- -- r b.p _ i
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------------
Si nature
jo r�7
Print or Type Name
Telephone Number
Date: 4

CAROL MARIE RENFROW
6-8453/2531
MARION RENFROW 601 006 3232
NCDL 2884598
2504 TRULL ST. SW PH. 252-291-5251 DATE
WILSON, NC 27893
LGFQFCU il LA6
Lj jc-"1
LOCAL GOVERNMENT 26
FEDER
EMOCREDIT D N I 0 WILSON, NC
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253 18453 7':0 1 006 23
23 21ll
2907
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