37262_CAPSHAW, RONALD_20040113

R Pi
r 1�CAMA / ❑ DREDGE & FILL
GENERAL PERMIT 0
Previous permit #
❑New ❑Modification ❑Complete Reissue El 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 Name
(ar ltGVV
Address
City iv, L,, r
State ZIP E ,
Phone # ( Q) (G ' / - (t ! %, j
Fax # ( )
Authorized Agent � , !d
Affected ❑ CW ❑ EW
❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF
❑ IH ElUBA [IN/A
❑ PWS:
❑ FC:
ORW: yes / no PNA
yes / ;no Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City .,� i 1, ZIP
Phone # ( ) River Basin
Adj. Wtr. Body N V !f _(nat man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
t+ i
(Scale:
)
Pier (dock) length
f-
Platform(s)
Finger pier(s)
Groin length
number
, ,
r..ct'�l
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
(
�L i rc
Boat ramp
Boathouse/ Boatlift U 1, i V (3 < i
u
Beach Bulldozing
j
Other
Shoreline Length
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no 1'
f
Photos: yes no
Waiver Attached: yes t no --- -
-- -- —
A building permit may be required by:
See note on back regarding River Basin rules.
Notes/ Special Conditions
h I ny / r, L'y
Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Issuing Date Expiration Date
Local PlanningJurisdiction 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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules F 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 complywith 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.nccoastaimanagement.net
Revised 10/05/01

UNITEDSTATES
�POSTA SERVICE® POSTAL MONEY ORDER 'wo
SERIAL NUMBER YEAR, MONTH, DAY POST OFFICE U.S. DOLLARS AND CENTS
06441,69278z =r _� _j ��,�,;y �4 , 1e 04� :11
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FINE HUNDRED DOLLARS & 00i�
AMOUNT
PAY TO
NEGOTIASLE'ONLY IN THE U.S. AND " OSSF. �;iil?�•:':
SEE REVERSE WARNING
ADDRESS
FROM
CLERK
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ADD / O'
C.O.D. NO. O } - I•l // I
USED FOR � 72 4-2-
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1:00000800 21: 0E44 I L 9 278 20

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
�ATEM3 T (ter 31
(FOR A PIER/UNCOVERED f
1 heroby certify that t owu property adjacont to Uf
(1'�aA►e of heater)
property Wiltod et LUmd
(4ot. Week. Aaaed. ate.)
NC
{yy&A�y) (To�nt at®al/ar County)
He has described to one, as sbawas below, the development bit is proPosiNg a0 tbA1 locatban.
&ad I have, as objeclW" to his prOpOsal, f uwdoratand'bat a P"erts"c"C"d beat lift must be eet
both ee a wlwisassa of Moo (15,,) from ay area of riparian accost aaaaSoes waived Qy me -
I ALAM wish to waive the setback r"Virome"l.
1 IN wish t% waive that setback regeiromeett.
DZSCRIPTION AND/OR DRAWING OF PROPOSRD DEVELOPMENT:
(To be oiled in by individual proposing developtnettt)
9,m•m
� � � � t �' a",►' -
Alp?
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S �auture�
Telephon# Number
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`Pant or Type Name
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ADJACENT RIPARIAN PROPERTY ®wNERs ' bA EmE �T
IFOR A, pizWVNCOV ERLD BOAT �,
t tiara► ► cest j► *at 1 �►a property sojecoot to2—�
11*ae"• at ha�(�)Wqer)
War• ► tsttatad a1 (Lat. beck. pined, y
in
(Town sad/or C.OIAN y)
its 6&# described to awn, as 11bo wn below, the develo far►swt be b prapasiy Ai tb*1 socomoft.
toad i leave as abJacliaws to" proposal. 1 004Mtawd that a p1emruncovered beet U11 M%"4 be ret
b"k at o tsill"a w *(O" (166) hraew my am of rivertaw aseaes sagas$ waived by Me,
i with to waive the setback r*464010ee1.
® Wigb to waive tbst •etbaeix requirewlawt.
PTIDa A6®5111 DItAWINC UP M- 8 ) DDEVEL®!'MENT:
(To be !ills/ in by individusi proposing dttvolopit+t K)
7sce -
i
7f tisr
�Y •
k e
w I
Al
S airs pry to a Typo Name
Telephone Number