38854_ANDERSON, WAYNE_20040910

CAMA / '- DREDGE & FILL
GENERAL PERMIT
Previous permit#
-New I'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
Cl Rules attached.
� AA
�t4 Applicant Name yO vO f n a 4f o f o-.
Project Location:
County 1,
Address +'% ? �hi�q �r�,IJ�
Street Address/ State Road/ Lot #(s) _ -
City. (,s,(n. State P 4 ZIP 2 2Ai�)
Phone # (���) 5'�9" �^�yC Fax # O
Subdivision
—
Authorized Agent if
City_.
ZIP
CW EW ® PTA El ES [I PTS
Phone # (_
River Basin y✓A 1, r%A F
Affected ' OEA - HHF ❑ IH ❑ USA ❑ N/A
AEC(s): -
_)
Adj. Wtr. Body
r
a• u►^ cinad/man /unkn)
-PWS: ❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Mai. Wtr.
Body
Type of Project/ Activity
Pier (dock) length
Platf
Bulkl
Basir
Boat
Boat
Beac
Oth<
Shor
SAM
Sand
Mow
Phot
Wain,
(Scale: Ali yc )
o
Finge
Groin
Bulkl
Basir
Boat
Boat
Beac
Oth<
Shor
SAM
Sand
Mow
Phot
Wain,
(Scale: Ali yc )
rm(s) - -- —
i
r pier(s)
length
number -
lead/ Riprap length
— ---
avg distance offshore r
max distance offshore ^
channel
cubic yards_
ramp-
iouse/ Boatlift 0- i V rVI, C
I
Bulldozing
r
i/
i
- tx
:line Length + ' --
not sure yes no i
nags: not sure yes mo —
�torium: n/a yes no
as: yes no I
er Attnrhar4 vac nn _
A building permit may be required by: f ! �� ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions r r s -,v 1 r I
r
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
A building permit may be required by: f ! �� ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions r r s -,v 1 r I
r
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 C; Other:
El 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 / 1-888ARCOAST
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
151-13 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

R. WAYTNE ORS p ANDE RSON
JACKSONVILLE, NC 28546
A
Pay-2�
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66-19/530 NC
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Bankof America
ACH R/T 053000196 .-------__,-- w
Memo
1:0 5 3000 1961: 00060 L 241313L. I� 4 3
,

(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOCSE)
I hereby certify that I own property adjacent to WaYWF-, G• ENO=���' 's
(Name of Property Owner)
property located at �T 1, gq
(Lot. Block, Road, etc.)
on �� l�v , in C-.x VP 2 � - , N.C.
(Waterbody) (Town and/or County)
He has described to me, as s;lown below, the development he is proposizz a7 tsar. location,
and, I have no objections to his proposal. I understand that a u--r/mooring
pilings/boadiftlboathouse must be se: back a minimum distance of fifteen feet ('15) torn my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
y' I s-4 wish to waive t:at setback recuirement.
DESCRIPTION AND/OR DRAWLN, G OF PROPOSED DEVELOP`IEti,T:
(To be fzZled in by individual proposing development)
o�
M
Signature
11/ /V /VS
Print or Type Name
41)
Te eph ne Number
Date: 5= OC, O /

(FOR A PIER/MOORING PILINGSIBOA TLIFTIBOA THOUSE)
I hereby certify that I own property adjacent to� C• Nib Sl�
(Name of Property Owner)
property located at i I- � 'I -1-7-C-IkN 773- VM1 1 G
(Lot, Block, Road, etc.)
on , in C�- l��1 t� �`C- , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shLown below, the development he is proposing- a. t:a: location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings,'boatlift/boathouse must be se_ back a minimum distance of fifte--n feet (i;") i'_m my area
of riparian access unless waived by me.
I do not wish to wave the setback requirement.
I da wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEVELOP`IENT:
(To be filled in by individual proposing development)
JE�,k4t K—.) (27)=C�C_u-
O
C
0
Print or Type Name
Telephone Number
Date: _�/3`� S--
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