51578_FARVELL, AL_20071010

❑ C�tAMA / @ DREDGE & FILL SIDW 1578
GENERAL PERMIT Previous permit# ✓`�' `'''/
El 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
Address
City
Phone # ( )
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ZIP
Fax # ( )
❑ EW ❑ PTA
❑ HHF ❑ IH
❑ FC:
PNA yes / no
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale:
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore "y
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
`
it
01
Shoreline Length
SAV: not sure yes no
I I
Sandbags: not sure yes no
Moratorium: n/a yes no.
Photos: yes no _
Waiver Attached: yes no
A building permit may be required by: - See note on back regarding River Basin rules.
Notes/ Special Conditions --
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, certifythat 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 (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
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)
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adj acent to irk— Ll"[I-,S
Q y1{o 1� l� �, O��.►.ez f�zG IVC
(frame of ;?roperty �witer or Applicant)
Phone number you can be reached at d sg' o� �i4 a O 6q
Mailing address if different from location:
Property located at PeA�i.yS� % �� ,
(Lot, Block, Road, etc.)
on 0 J^ -(f _CPP%� , in—�& c 0 , N.C.
(Waterbody) (Town and/or County)
He. has described to me as shown below, t�hc d3veloNr�.:,:,t 11�+ is proposing at that location,
and, I have no objections to his proposal.
NaN vrotN
erofRe 1�
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
----------- ------
Sim
a
Print or Type Name
Telephone Number
Date:
nccoastalmanagement.net/PermitsIADJACENTRIPARIANPROPERTYOWNERSTATEMENT2. pdf

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1hereby certify tll.at I own property adjacent to
(Na.me of Property Owner or Applicant) /
Phone number you can be reached at y-'—- Oy .57^U ,
Mailing address if different from location:
Property located at 7 w (�Niti5�1,
CG(ST//V�
o/Vo1rgN
Prorrf�y
X'1(t,L, , yC,Fs a1 ,
(Lot, Block, Road, etc.)
on (0/' moral 011e C' li , in N.C.
(Waterbody) (Town and/or County)
Ne hag described to me as-.h--wr, below, tl.c dc;vclopmeni he is proposing at that iocadon,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development) T(1y
Pin OS�.L 1, Y1 5 �/,PT
e0l
015. r
Rif R4e
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Pa ( NN-0-y9AZ
Print or Type Name
_ '�2 /�(9-00
Telephone Number
Date:
nccoastalmanagement.net(Permits/ADJACENTRIPARIANPROPERTYO WNERSTATEMENT2. pdf

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