36671_BLACKELOCK, CHRISTA_20040416

❑ CAMA / F- 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
i ❑Rules attached.
Applicant Name Project Location: County
Address
City 7y' ' State ` ZIP
Phone # ( ) ' /'Tax # ( )
Authorized Agent
Affected L- CW ❑ EW ©,P'1rA ❑ ES ❑ PTS
AEC(s): L OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Type of Project/ Activity
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 4,z V: ►t
Shoreline Length
SAM not sure yes
no j
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
(,h r y�IA ke 10(
Agent or Applicant Printed Name /
Signature Please read compliance statement on back of permit
Street Address/ State Road/ Lot #(s)
b '
Subdivision
City /V t' ZIP
Phone # () River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: )
'See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date
Expiration Date
Application Fee(s)
Check# Local Plan ningJurisdiction
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 I) 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
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

B�KELOCK NCDL 3842231
PHR52 63 _1803
603 ,REXI 60D DRIVE
NEW BERN, NC 28562
i
PAY TO THE
DER OF C
OR
t��)� 4l•v�:� i �tii�l✓t- � t G
1775
66-7704/2531
ees
' Credit UMOn
State Employ ,�
Nero Be-4Narth Carolina ��
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MAY-21-2003 WED 08:58 AM NO DIV OF COASTAL MGMNT FAX NO. 4 P. 06
ADJACENT RFPARLki PR0PERTY 0WNTR STATENIENT
(FOR A PIER/MOORING PfL&GSIROA7Z,1FTIROATHOCSE)
I hereby u:-6fy that I own property adjace'It to `il & I '1 s, vfc�a,-So 's
C`iame of Property Omer)
pro :-,y located at �(e�p_ k.w�b63, br"; ve
(Lot; Block, Road, etc-) on 111 ( ( �/U
(tiyaterbady) (Town and/or Countv)
ire has de : on to rant, as sown below, tie dzvc!oornz:,t he -
is pro�,o__.-._a: t;,St location,
avid, I have no obje dons to his proPos� -s�.d �._. -a ,
I LiiGz, ;r Glo
pI11.ii�srGOcuiri%UocC�Ol!Se mlfsi r _ - p;z orr�
be : ba 't a minirum dis�nce o: ritieea fe:: (':i') Fom my ere-
or" r•`pa:Ian cccess Ur,l!ss waived by me,
I ,d! not LV1Sit to the setback re uir-m,= ,c.
sin Wish to 4va;ve t :.t serbac' c��
DESCT-UPTION A WOR D[:. VyrL G OF PROPOSED DEVE ^0,oN .E-------------
(To be filled !� by i,tdivLyuel pro poszr_g dr•r,Flopl,tEnr) fE\?,
`,r''.,-4- 11"lQ /.2-1 C(JLk
p,-� /I-1P
U I
Siona*ur j:
vl�/r—
UU �✓ lrvlX�
Print or Type name
Te!ephone %'.:m�e-

MAY-21-2003 WED 08:58 AM NO DIV OF COASTAL MGMNT FAX NO, 4 P. 05
D 2004
ADJACENT RIPARLAN PROPERTY OWNER STATEN ENT
(FOR A PIER/MOORING P11-1rVGS/a0A711,FTIBOATHOCSF
I hereby certify that I own property adjacent to 6,_21-L,1�
(Name of Property O Wirier)
prooe.-.�y Iccate:l titCr��'-vjood
(Lot; Block, road, etc.) '
on J1 S °y:` �� .. , in f (�c1 (,� �a cQ 5
(Waterhod_v) 1 N.C.
(Town and/or County)
He has d--s,,,1bc-J to me, 2s s;lown below, c;e dev ' _
end I � e-Opme:,� F,e is propos:-� �: G`�[t loccion
have no objections to his proposal. I uncer;�nd '
pUli �Si (iQc. Ir�Oe�hQllS: 111115t be Sc_ p^�� t,-a_ p:e:, moorng
a minimum distance of Ff�ee , fee- (' 5') from my area of r,'p�:�n access unless waive.�i by.me. -
�n rn wish to w•a;v; Oe setbzck requir.-mie.jr
`�^ I do Irish to w2.;v= t ;at
cbeck rc,i(z C.
DF-SCRIPTIO:N AND/OR DRAVVD G OF PROPOSED DEVELOP L-E\ j : ----- - -
(To be filled to by iRdividual proposing dev2lvpmeRt)
✓v c 1,4ee-
7d ' 66 c ---11- cloC-k.
1'7-
'Inc or Tyre Nome
Z
Te?epncne Numbe;

April 12, 2004
NC Division of Coastal Management,
APR 1 3 2004
I am enclosing the information needed to obtain a general permit for construction of a
boat dock at my house. Enclosed is two written statements signed by the adjacent
riparian property owners indicating that they have no objections to the proposed work,
information on the site location and dimensions of the project area, and a check for $100.
If you need anything further, please call me at 252-635-1803. Thank you.
Elizabeth Henderson
603 Creekwood Dr.
New Bern, NC 28562