52142_GROVER, TOM_20080102

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❑CPM.A, / ❑ DREDGE & FILL 1.�I€�r `
GENERAL PERMIT Previous permit#
❑New El 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 I SA NCAC
Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
CityState ZIP -
Phone # ( ) Fax # ( )
Authorized Agert
❑ CW ❑PW ❑ PTA
Affected
❑ OEA ❑ HHF f 1 IH
AEC(s):
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
-]ES CIPTS
UBA ❑ N/A
Crit.Hab. yes / no
Subdivision
City ZIP
Phone # O LI i~' 7 River Basin
Adj. Wtr. Body r 1 i : j -t'I t7' i� !(nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: i ' (711Il F )
Pier (dock) length
Platforms) I
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel _
cubic yards
Boat ramp
vL. i
Boathouse/ Boatlift
Beach Bulldozing
Other
_
a
-
r
Shoreline Length
SAV: not sure yes no II'
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 **
LC -
Permit Officer's Sigrrtur
Issuing Date Expiration Date
1'
Application Fee(s) Check # 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, 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
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

North Carolina Department of Environment and Natl_lral Resources
Division of Coastal Management
lylichael F. Easfey. Goverrier Charles S. Jones, Director 'Ni!liaT G Ross Y . Secretary
Date
Applicant Name _ on-�
Mailing Address
-- . _ - . i A \ / ' rl E l -
(' aSaAq - r lam t
I certify that I have authorized (agent���t�(� _ �lG�( to act on my
behalf, for the purpose of applying for and obtaining all C'ANIA Permits necessary to
install or construct (activity) ( � � l -1—t— r
at (location) s��� otV reA-, N\ mINIIT `�i`
'This certitic is valid thru (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] intemet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 501,16 Recycled 110% Pest Consumer Paper

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http://gismaps.cravencounty.com/maps/map_print.asp?pid=5-012-1-OOC&minX=2669992.... 1/2/2008

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILIIVGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to 't��_•s
(Name of Property Owner)
property located at ip# 1 p r ( a
(Lot, Block, Road, etc.)
on t lK, in A , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatUaWboathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement_
r I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: T �Y
(To be filled in by individual proposing development)
Signature
,D M ij PH
Print or Type Name
Telephone Number
Date: r1c' 7

Dec 12 07 11:58a George Garance
1704-528-1329 p.2
ADJACENT RIPARIAN PRO'PERTV OWNER STATENIEN'll-
(r,oR4I'I�R/jvo0 txi ci Pll-zNGSlna4Tirr-TlBo.4Titot.,il:;
cerfl . that E Sl'r:31 !-m) L'r.y Ca:'ac-ent t�1
flame of Prnperty Owner)
ro;x.rh� loc:at^d at �— `� - y. -�. � r: ; �. — _ _';'� r , -' • -�.(_� .,; ��. �-,-
(f.-2, Block. Read, etc.)
„� _ I_: I� . N.C.
(Waterbody) (`i om-n and!or Counf.; t
He has describe& to me, as Shtrv:l iie is prOposIrnt' �l_f.t k cz"on-
artt>, I :lave ao obj...fin:ts to iris proposal_ 1 utleicrsianP.. that a ;�ie':':11oarn� pilincs`haatlitt,'hoat:E;>>us�
must be set -buck-a minimum disc: nee of* fsftLen foc+ (15) from my argil of riparian. access unless
,vaivtd by me.
I do e9t .:ish is %va;vcthe setback -C.uirc::1cnt.
1 do t,isn to waive that setback- requirement.
------------;-------------------- ----------------------------------------- --
DEkRiPTiON :,%A-D!OR DRAWING OF PROPOSED DEV['.I.()PME:: M1T:
(To he filled it bt! individual o�oPncinr; devrlopmern6
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