39656_CARY, CLIFTON_20040817

CAMA / ❑ DREDGE & FILL (we 3' ✓�W ,fr..
GEN
ERAL 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 Resour9qs Commis ion in an area of environmental concern pursuant to 15A NCAC vC
o, $ l p t P�lRules attached.
Applicant Name (` i ' « (' v 1 Project Location: County
Address lit } t f.?,0 Street Address/ State Road/ Lot #(s)
CiState /�� ZIP
Phone # Fax # O Subdivision
Authorized Agent f Il. 5 City ZIP
Affected ❑ CW 0 EW R PTA ❑ ES ❑ PTS Phone # ( ) River Basin alb lr Oo K i
❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): El OEA Adj. Wtr. Body r~':,5,if [u u ►- d gai /man /unkn)
❑ PWS: ❑FC: y
Closest Ma Wtr. Body
ORW: yes / no PNA yes / (no Crit. Hab. yes / no i'
Type of Project/ Activity r i- I ,•. , r, r{ r �., 1/ , d� 1 1 ( P
I !
j rt (c 1 '�, • Y , _ of c c r r r 1. (Scale: ^✓c ✓r )
Pier (dock)ilength j
Plnrfnrm(d --_-_ ..� !'...t i f
Finger pier(s)
Groin length
number -- -- --. i77-- o
Bulkhead/ Riprap length
avg distance offshore
max distance offshore -
Basin, channel -- - 1-- — - — -
cubic yards I
Boat ramp
i
-------------- -
Boathouse/ Boatlift I' < �.. P ; _ -- -- - - �e Q� 1
Beach Bulldozing ?r ^
Other I
Shoreline Length
SAM not sure yes
no
---
--,- -i T -
Sandbags: not sure yes
no
- tci w } t..(, I'
i
-
Moratorium: n/a yes
no
-
Photos: yes
ho-
Waiver Attached: (yes,:
no
- -
A building permit may be required by: ��f r� �� "� 5
❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
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Agent or Applicant Printed Name
r--
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
,'gat 4,
Permit Officer's Signature
(, )l r H
Issuing Date Expiration Date
Local Planningjurisdictiofi 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 ❑❑ 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
151-13 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

ERJC.B. ELLIS NCDLs5oa7
----------=2782�„2-�
JASA ;M. ELLIS PH [phone]
`'205 N0Tr1NGHAM DR.
MY, Y, NC 28557
Date 66-30/533
O
Pay to the
Order
of
Dollars
FIRST CITIZENS 133
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jyu �i»'Atl�n(iC Basch, N.C. 28512
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For �Li /�Tt�
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JUL 20 2004 11:14 PR TO 7266775 P.01/01
GYJ d'Jfld SGGy yCG CSC ZS : ZI b082 el -In1'
ADJACM� RYPARLW PROP -ry OWPNF;R STATE•
(FOR A PIRRIUNCOVERED BOAT JJM
i hereby cemfy that I own properry adjacent tao ,
C 3
Zof�Prop�erly p.. ex)
Property located at
mot,
on 1
(Wa ody)
toad, etc.) in <� ,
04
(Town abdlor County)
$lock,
He has desrribW to me, as shown below, the development he is proposing at that
location, and, I have nc objections to his proposal- I understand that a piuYuncovered boat hfc
must be sex back a mtnimurn distance of fifteen feet (15') from my axes of riparian access unless
waived by me.
/ I do not wish to waive the setback requirement.
V I Jg wisb to waive that &Aback nquirement_
Lr.�cx�zvr AND/OR DRAWING OF PROPOSED DEVEWPMENT:
(To be filled iat 3y ri%Wmdrlal proposing dove apmenx)
a a
Signature
Susc"A
Print or Type Name /-3�3�6
Telephone plumber
Zoo[j DI93 —LL9 9% ZSZ YVA Sb:11 toaz/gr.111
+ TOTAL PAGE.01 ��

RUG 10 2004 09:15 FR
TO 72667755 P.01
** TX C0W1RmA710N R�PCRT **
DATE T I t E TUYFROM
05 07/20 11:13 252 726 6rrS
Grp SJOd y: G J ECG CSC
RS OF JUL 20 2PO4 11;111 PPGE.01
MODE MIN/SEC PGS CMDU STATUS
EC--S 00' 22" 201- OK
-� ------------------------
ZS:9T eee2 et -Inr
ADJAIIUNT RIPARIAN PROPUM OW?�" nAM r
(FOR w NEWWWOVERW sOnr L M
1 hereby certify that I o" papeny adjacent io �� `' s
L _ ame of properly (3whw)
property located at�_
(I,,ot, Block, Road, etc.)
in
fy`,= Yl Rowe M&cLr County)
lie Qas flesaiNd to me, as shown below, the devabPOQtt be is prWo5ft at tbat
location, and, I have na *ecdoos to his presposil- I mdcmnd that a picrfWw&vesbd boil lift
mu% be so back a minimum distance of fifteen feet (15') fmm my area of t'V='ian aces unless
waived by m
3)M
{{�� T do not L►ish to W ve the sabaclt jaqU4vmenL
tt I wisb to Waive that sahark ssgt+itts t.
DESCRWnorY A DIOR DRwWWro OF PROP -11= DEE,pPhMIT:
(To be Jilted Is by ra&riduW propaQwg dcvdvpnteu)
V
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+. TOTRL PAGE. 01,