36619_BROOKHART, JODI_20031027

DCAMA / J 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 15A NCAC
❑ Rules attached.
Applicant Nameg' i ;_{ ; jC,T, :� - Project Location: County
Address_
Street Address/ State Road/ Lot #(s)
City I State ZIP
Phone # (y ) -1 Fax # ( ) Subdivision
Authorized Agent �r j / City ZIP
r
Affected L' CW ❑ Ew PTA El ES [IPTS Phone # ( ) River Basin r ,k}. i
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body nat man unkn
❑ PWS: Cl FC: \
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wrr. Body ti .
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
Bgatramp
Boathouse/ Boatlift )
Beach Bulldozing
Other
(Scale: )
Shoreline Length: �' t
SAV: not sure yes no —
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no -- -_ — ---.-
l; -
A building permit may be required by: _r See note on back regarding River Basin rules.
Notes/ Special Conditions t
r
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
l
Permit Officer's Sienatur
If � 0,) /-c, i I ') J /(- 11
Issuing 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, certifythat this project is consistentwith 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 / 1-888ARCOAST
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-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

HARRIETTE L BROOKHART 5703
MORRIS V. BROOKHART
NCDL 194695 NCDL 2536054 66-7704/2531
1708 EMERALD DR. PH 471-3372
EMERALD ISLE, NC 28594 hATP
PAYTOTHE Z $ C 00
ORDEROF IJ
State Employees' Credit Union
Morehead City, North Carolina
62
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FOR(`� 3�21-1____----------------------__-----------_..-.-----�-
i:2531770491:08606384L99Ii' S703

ADJACENT.' RIPARLAIN PROPERTY OW-N-ER STATE: IMNT
(FOR A PIER/MOORING PILINGSIBOA77-IFTIBOATHOUSF)
I he,eby ce:�y that I own property adiaceat to _ J 01 f . g rOOVIQ &- s �s
(Name of Property Owner)
pros .7L locatcd at t 7 ov E*%e ra Cd Pr -
(Lot, Block, Road, etc_)
on 0 q l,W— 5WAA , in C AA&e-V-CLU I:S(e . 1_AC , hr.C.
(S 'aterbodv) (Town and/or County)
F_- has QeaCitJe` to lice, as s::own below, t .e deve�op�� e:,_ he lS propo: - c: t`.ai ioCai oi:,
and, I have no objections to his proposal. I a pier/mooring
plli �5in7c `�rur0oci"ioL's: Musi be C.' back a miniim m dIsianCt o' I?eizt;1 f (:5) fiom lily a_ta
or rI',)a7jLn access u-iess waived by me.
I dn not wish to tie setbac": requireme:,_.
V_
I an v,is:i to waive setback rc���ire, ,e:<<. '35
DESCRIPiIO:N; AND/OR DRAWFI G OF PROPOSED DEVEL0 %IE\7:
(To belled is by irdividua! proaosr;; cE.e!o.urzerr)
C o w 5-vwu A roart o ve v- `-o
f2VV+e_C_ r 7o vt -}oow looa,*' mot:;'
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ADJACENT RIPA.RLLN PROPERTY O'V i�-ER STATE -MINT
(FOR A PIER/MOORING PILINGSIBOA TUFTIROA THOUSE)
t cv- s
I here: ti heresy cry that I own property adiacen[ to Odd � , groo �--�'1
(Name of Proper-Ity Omer)
prom.,y located at S C me ra Cd Pr -
(Lot, Block, Road, etc.)
on 15pq Ue— 5wvA8 , in E—WleVaU IS(e , 1'A , N.C.
(A'aterbody) (Town and/or County)
F.-- has deS:.%uc'_:1 to rice, 23 s;i0wn below, t:`:e deve'opim--n: he is a: C,ct location
and, I have no objections to rigs proposal. I unde;si�:d t�:a: a pie:/riloor,rE
pLLii �Si Cn7ci!Ii�00cC lOI S.' musi be sz, bac'k a. miimlmiium distLrice o" Fi f-Lt�,i fe;: froth lily cfe':
or rioa-ian access unless waived by me.
I dn not wish to wa vC the setback require te::.
15 t wish to v.al,ve t::E. S,—bask rc ire,Ti ;ti.
DESCPSPTIO,.N AND/OR DRA`i r G OF PROPOSED DEVEL0P%FEN7:
(To bulled i� by irzdi�•i^u^l proposirz; c ,elopmerzr)
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ADJACENT RIPARLAN PROPERTY OWNER STAMNENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOCS£
hereby ce:afy that I own property adiacent to
(name of Property 0;: ne.)
prope:V located at t -7O$ E~ rt- (d
(Lot, Block, Road, etc.)
on Ve_ 5WAAA , in EwteVMU ls(e , 11C , N.C.
(W aterbody) (Town and/or County)
He has described to me, as shtown below, the development he is propos - a: that location,
and, I have no objections to his proposal. I u:,de:szand t`:=: a pie:'moor-:rE
pu.ingseboar-li boathouse must be se: back a minimum distance of f Reel f:--: (15) from my are
of riparian access unless waived by me.
EOF
I dn not wish to wa ve the setbac requireme
I fin_ y. ish to w;2'L;ve �. setbackrec�:ire.;�e1;.
DESCRIPTIO- AND/OR DRAWENG OF PROPOSED DEVELGi�%fENT:
(To be filled ir. by indiv&ual proporip..; d_ �e!opnenr)
CA w 5�vuc.-� "of ove r
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Print or Type Name
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