47187_ROSE, ED_20070117

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
[]New ❑Modification El Complete Reissue ❑Partial Reissue
As h ' d b th State of North Carolina De artment of Environment and Natural Resour
Previous permit #
Date previous permit issued
aut o, — y e p
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA C
Applicant Name—
Address— E L` i n L -
City r• �. t,., r � State
Phone # () 171 - 1i r'i' I Fax # ( )
Authorized Agent
❑ Rules attached.
Project Location: County J N
Street Address/ State Road/ Lot #(s) f `%
Z!P�-
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ElOEA ❑ HHF ❑ IH ElUSA ElN/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Subdivision
City i ->._ %nr o ZIP
Phone # (_ ) n River Basin c J cv 4
Adj. Wtr. Body A j L,\.J '(n t /man /unkn)
7
Closest Maj. Wtr. Body,\Q Opt t''
Type of Project/ Activity
/
(Scale: )
_
I
Pier (dock) length
Platform(s)
Finger pier(s) --�-
Groin length
number
Bulkhead/ %prap length-
avg distance offshore
max distance offshore
Basin, channel
cubic yards -
Boat ramp -
Boathouse/ Boatlift -
Beach Bulldozing
Other
-
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no -
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
— —
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on back regarding River Basin rules.
See note
- i� . 0 � <:f, -
Agent orAp licant Printed Name
Signature Please read compliance staiement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
/- / ) - c I I/-
Issuing Date Expiration Date
Or, >!n�,o Co, Xb)111 0A
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, certify that 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
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
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
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888ARCOAST
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

ADJACENT RIPARLAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to Le n a s
(Name of Property Vwner)
property located at I 7` i /O/iIr1U L. N Ulu (! F1
(Lot, Block, Road, etc.)
N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, 1 have no objections to his proposal.
nEcrurwrrrON AND/OR DRAWING OF PROPOSED DEMeOPMEYT
(7'o be fjllodi.hu� i-- A r`wpment)) -�
:;t�UT(`3rL GsA(74t _- VA -MnE
Popes
Print or Type Name
Telephone umber
• f_
Date:

ft - -
CERTIFIED MAIL ♦ RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: �//��� �UG1�
,
Address of Property: l/ � 70
(Lot or -Street #, Street or Road, City & County) Q/VfLb�
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development they
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Management,
Hestron Plaza II, 151 B, Hwy. 24, Morehead City, NC, 28557 or call [phone] within 10 days
of receipt of this notice. No response is considered the same as no objection if you have been
notified by Certifted ,Mail.
WAWM-SECTION
Lunderstand thata.pier,dock mooring pilings, breakwater_boathwse, lift or sandbags.must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive the
setback,, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature / Date
Print blame
Telephone plumber With Area Code

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to aoi-I Ir c-M"6 Aix 's
/ (Name of Property Owner)
property located at Nofl ` - -)/, ,
(Lot, Block, Road, etc.)
on /�1/L �-� �-� , in 0%Jr40G4) , 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.
Ra&,4 7"
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be fjllodinik„ ., „1-,pmeno -
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A RACll to exPIT-10-C z
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Signature
Print or Type Name
Telephone Number
Date:
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