50784_VICKERS, JACK_20080520

s/z�lo C] CAMA / DREDGE & FILL y J IV �' 5 `� 8
r. GENERAL PERMIT y 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 a7,ar'e1a of nvironmental concern pursuant to 15A NCAC
�L K�^� ❑ Rules attached.
Applicant Name Project Location: County
Address, �! i ��� Street Address/ State Road/ Lot #(s)
City j State °- ! ZIP
Phone # 4n') fax # ( ) Subdivision
Authorized Agent �' '. ; j 1 City ZIP
Affected ElCW ElEW ElPTA [IES ElPTS Phone # (_) 7 -- ;? ;.River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 1nat /man /unkn)
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
(Scale: )
Platform(s)
Finger pier(s)
j
l
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
—
c o
cubic yards
Boat rampLA
Boathouse/ Boatlift
O J
o u
ai
o Q
Beach Bulldozing
Other
N
N
o
i;'
Shoreline Length40
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
_
c r c°
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Waiver Attached: yes no
/ r
A building permit may be required by:
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
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, 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:
❑ 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
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
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)
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 08/09/06

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOA TLIFT/BOA THO USE)
I hereby certify that I own property adjacent to7�'.��/`, enrL is
d
(Name of Property Owner)
property located at o C) WCo
(Lot, Block, Road, etc.)
on L z in /. 117 , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pil ipgs/boatlift/boathouse
- -
must be set back a minimum distance of fifteen feet (15') from my area of Ctparian access upl,ess
�
waived by me.
Wy ti 1. 2008
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement. Morehea01 'ItV DCM
--------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fillet! in by individual proposing development)
pplicant Information)
Mailing Address
City/State/Zip
Telephone Number
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(Ripariaroper O��ner Information)
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Signature
Print or Type Name
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Telephone Number
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Return Receipt Fee
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(Endorsement Required)
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Restricted Delivery Fee
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Total Postage & Fees
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Street, Apt. No.; or -PO Box No.
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City, State, ZIP+4
---------- -----------------
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Grsgson, Director Williar'i G, rinss jr., Secretary
Date c
k Applicant. Name
�! Mailing Address
I certify that T have authorized (agent) �'�4���n ���•�� ; to act on, wV
behalf, far the purpose of applying for and obtaining all CANIA,, Permits necessary to
install or construct (ar- ivity)
at (loentioti) �Z(--uw Na Z-��7-4
This celrtificatiou ' valid thrut (date) __
Signature ' V LAC,,-�
400 Commerce Avenue, Morehead City, North Carolina 29557
Pnone: 252-808.28081 FAX: [phone] Internet: www.rccoastalmanagement.net
An Equal Opporwn ty 1 Affirmative Action Errployer - SO% Fecyclm 1 t o% P= Corsumer Paper
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CIERYL H FULCHER 213
EMMA CECILIA NOE NCDL 4692719 812158 "' �,
P O Box 221 Th 252-725-7464 5 66-21/530
Harkers Island, C 28531 a 77585
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