38841_AMAN, GENE_20040603

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�'CAMA / ❑ DREDGE & FILL dA
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 j
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 746 1240
' ❑ Rules attached
Applicant Name
Address J 5 1.5- g V f j 5—r
City . C ltv State ZIP , 7�1 OF
Phone # ( t + ' 54 Fax # ( )
Authorized Agent ,>/
Affected ElC�'�
Cw W �TA dS ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / `no, PNA yes // oo Crit. Hab. yes / no
Type of Project/ Activity / A/ ` U
Is geA
T
Pier (dock) length 6Q
Platt
Fingi
Groi
Bulk'
Basic
Boat
Boat
Beac
Oth4
Shor
SAV:
Sanc
Mor
Phoi
Wain
Project Location: CountyCArTe,--zoc-x
Street Address/ State Road/ Lot #(s)
4 v e Drz
Subdivision
City 2 ZIP �k`5S J
Phone # ( ) River Basin /! ZV
Adj, Wtr. Body ` c A ti°- nat man unkn
Closest Maj. Wtr. Body O N
T L/ 1!/')r f_' i! ;C:kA -7r7" w
(Scale:<j )
irm(s) ®fir ?t L' �`•
r pier(s)
i length-
number
lead/ Riprap length
avg distance offshore
max distance offshore
-
._
_
�.
I
_
Qom . -
�
/I t
(Jo)
AI 7'47 4 � � ��""f
_
r
_I _ +
i
/
�,
fir :
,channel
cubic yards
ramp
sous / Boatlift
�—'
r5T r w V, tip'
- -
i Bulldozing
r
One Length /
n
not sure yes
Yes
dorDagsumnot sure /a
as: no
er Attached: y no
�/}�
tot h
J
/
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
2Ar A7'r T4 aae®✓
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( C 151116
Agent or Applicant Printed Name
Permit Officer's Signat re
6/5,%y A(by
Signature Please read compliance statement on back of
permit
r n/J l
Application Fee(s) Check #
Issuing Date ( 1 lExpirabon Orate
Local PlanningJ10Kscliction 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 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, certifythat 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 (910-395-3900) 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 / 1-888-4RCOAST
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

ERIC B. ELLIS
NCDL 65047
\.r pH 252 726-6TI5
:JASA M. ELLIS ,
,`,' •" 205 NOTTINGHAM DR.
MOREHEAD CITY, NC 28557
2720
66-301531
133
Date4_3 0_�_
$160 oc-
ray to. 8
Order of O Dollars
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04/26/2004 19:49 9e3615669198361565 GENEAMAN PAGE 02
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PtERIUNCOVERED BOAT LIf7)
I hereby certify 'that I own property adjacent to retie- I' ilc je,/ 4 nAt i 's
(Name of Property Owner)
property located at 4;4 �6b aA- )�M- VA -
(Lot, Block, Road, etc.)
on T360%vc-, 3wA , in f"I , N.c.
(Waterbody) (Town and/or Ca ty)
He has described co 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/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me -
I d"owish to waive the setback, requirement.
I dg wish to waive that setback requirement.
------------------------------ ------------------------
DFSCRIYTlON &ND/OR DRAWING OF PROPOSED DEVELOPNtENT:
(To be JWed in by individual proposingo development)
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04/26/2004 19:49 983615669198361565 GENEAMAN PAGE 01
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ADJACV4T RiPARMN UI'RR'!'Y Obi STAT.F.N YT
(POR A J ,f=IVNCOVMW BOAT LJF7)
2 hereby ratify That i awn prvpeM aQwAst w �P.�! NG`t.! 4,4—•s
/ of I'Xx►prsty Owater)
picMvy k wW at _ t 7--7- �J`� - a a �
�� I�..��/ - _ ►'fir,
t aAVt. SAMA. Read- WC-)
i
an t- N.C.
stel�Aody) crown sewer coroty
He has desQiDed ao a*, as sho" bsbw, do doVdagnmt ha is peopOdad at that
jo=dm, and, I have no objeatioos W hit pwOpiML I UWW*Nnd drat a P'i host }�
must be sot back a ndnimu t: dis cs OEIillMlio tat (13') ttvut tt�► ars+s of rtparia:s aoca�s utsM�
rri•ed are,
I A,IW wish oo waive tM utbac)t MqWnmML
DFstanmON AMWOR MAVrM Or !d0lO D DTwvxWpNipkrT:
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Print or arse
T69*c a Number

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