47027_ROUEN, ILSE_20061114

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Previous permit #
❑New ❑Modification ❑Complete Reissue
[]Partial Reissue Date previous permik issu d
As authorized by the State of North Carolina, Department of Environment and Natural Resources
�4
and the Coastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC
❑ Rules a hed.
Applicant Name
Project Location: County
Address t '--h' =
't' ` Street Address/ State Road/ Lot #(s)
City y State •✓r ZIP
Phone # (} Fax # ()
Subdivision
}
�J Authorized Agent (
City ZIP
EJ CW EW D PTA ❑ ES ❑ PTS
Phone # ( } River Basin `
Affected
AEC(s): OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab,
yes / no Closest Maj. Wtr. Body _
Type of Project/ Activity 1
Pier (dock) length_
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length,.
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
(Scale: )
4
i
r
� i M
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name Permit Officer's Signature
Signature "Please read compliance statemen %y D C - g Date Expiration bate
ApplicationFee(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:
❑ Tar - Pamlico River Basin Buffer Rules
❑ Neuse River Basin Buffer Rules
❑ Other:
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

Nov 02 06 03:51p DREW LUTHERAN 252-354-6294 p.1
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nit
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1 Fduhc- ha%-dC,;m7l" to roc, w.-Mlo wn below, * is propcuing at Ormt
b+c;atic,n' ��tixl 1 imVC Ito obiacfinas to rjL% Proposal, l uaxio/sU*d that it picrhnouring
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Date: G J

Nov 02 06 03:51p DREW LUTHERAN 252-354-6294 p.2
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P12C}P1R'RTY OWNF.R STATEMENT
(Fft.�,t I'l/s,�/t19(Dtiilfn'!;l'lLI1Vf;.L'111t1.97'I,11�7%IIU.tT1lUI1.5L')
I lierc.l.r,y iX lifp that I �MVJI propcxty adjacent to 56
(Nllnic of Property Ownej)
trrul,t•rty Ic�,•:sl.ci ::i... ... -7"? e�rj'
(,Sircrt Ad(Irms, Lot, Bind, Riiact, etc;.) r
011.
(Wal eri)4 fdy) (Town a)trllor Cou,tty
J f .Id)v JIA!; -Jn Wibc d to Mic, as -shown bolow, be (4:V00polent he/she is I,rofx)sing at til;tt
lc►ulti{ut • nild f ha o i,n abjrwir►ns W This rrPpOJSzO. I untlorsland that r? k2icr/mooring
pi Iill,'A)J>.yt lifrithr ;a"xi.w nulst be set h-XIC a in61imulu distance offitteeii feet (IS') from my a, ea of '
uccltss %vAiVW hytcte I Icave. indic acd city inientious by in;fialing below:
141.0 act'nl4e0. to waive the 15' suibnc:k requirt nent
�► ,,,__ I;1sJ 1Afcx; to waiv(; 01015' set.ix-A rem,ircin(mt.
t11:fLl�li+�
�.DERI€::Iii,1i1°li IMI ANNOR PHAW1'NG OF JI Rorosm) DF.Vrl,t7P .~ ~_... MEN'1':
{`f'o y�" llerl fire by individurrl proposin development]
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Friut or Type Name
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Telephone Muliba
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Nov 17 06 10:38a DREW LUTHERAN
252-354-6294 P.1
R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
klirhnel F E2slev. Governor Charles S. ,!ones, Director %Vfliam G. Ross k., Secretay
Date / / 1-7 0 �-'
Applicant Name��
Mailing Address '7 �'`� �rxc•iG✓ �x� �-e
67 1v - - 4
I certify that I have authorized (agent)to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (actitiity) IZe.�•vin �,,al I _ ,
at (location) 7j -2 4 SQu,;,Id del 'y
This certification is valid
Signature
/Z-/-4-'C�
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] l FAX: [phone] Intemet: www.nccoastalmanagement.net
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