47118_ROSSI, GENO_20070105

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issuoA
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal ResourFes Commission in an area of environmental concern pursuant to 15A NCAC (C..
MRule attac d.
Applicant Name Project Location: County
Address / v % : i ��G l S f F Street Address/ State Road/ Lot #(s)
City �� +" State: ` ZIP
Phone # ( ) %" Fax # O Subdivision
Authorized Agent 'If f 1r' City w A ��� i >i ZIP
❑ CW DEW i -PTA ❑ ES ❑ PTS Phone # ( ) River Basin
Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no., Crit. Hab. yes / no
Adj. Wtr. Body AJ /2- I"''atf/man /unkn)
r f
Closest Maj. Wtr. Body I � �`�
Type of Project/ Activity
Pier (dock) length_��
Platform(s)LAP-
Finger pier(s)
cn
% (Scale:
Groin length
number
Bulkhead/ Riprap length
avg distance offshore---�—
max distance offshore-
-�
Basin, channel
cubic yards I
Boat ram
I
Boathouse/ BoatlA !f / 1
Beach Bulldozing
Other
Shoreline Length ? - _
SAM 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
`�
- --
-
- --
—
-- --
- _
-• --
--
- -. - • _.-
_ _
j
- - - --
River Basin rules.
- - —
on back regarding
-- ---
❑ See note
(01
),A /-- I-Y 4
Agent or Applicant Printed Name
Signature Please read compliance statement on back of perml
r% > V
Application Fee(s) Check #
Permit Officqr's Signature
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, 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 (252-946-648 I) 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

1
ADJACENT RIPARIAN PROPERTY ONV`ER STATEMENT
(FOR A PISAIN100RING PILINGS100A7-LIfZ'1&0A THOUS-0 ;�� 11--3 4- �
I 'iereby certify that I own propeny adjacent
b (Nttrne or Proper(% Owner)
�� r
property located at .. l ---
(Lot, Block, Road, etc.)
ti2�ry , 2 �� N.C.
on � ,�, in _
(� ate ) (—fo%vn And/or County)
Fit has described to me, as shoo n WwA, the devetopment he is proposing at that iocstion,
and, I have no objections to his proposal I understand that a pier/mooting p' 'n s'boatli"Cathouse
,must beset back n minimum distance of fifteen feet (iY) from my area
%valved by me.
I dg no wish to waive the setback requirement.
iA N
I do v6ish to waive that setback requirement.
2 006
..............................................................................MoNtearl-fifty-OCM
DESCRIPTION ANWOR DRAWING OF PROPOSED DEVELOPMENT:
(To be filler! in bV i►tdivithial proposbig devtlop111enr)
- w
14"
...................
IB
Y1
........... ....... * .......... * ------------------- -------- ' ------ * ............
Signature
ehrl-e S L142�i 5
Pnnt or Type Name
_;,-> _ ZI 7 -!�-o _
Telephone Number
< <" k / Pate. F �� — 30 -- 6�'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(MR A PIER/WOOJ JNG P11INGS/BOAT1,lf7Y60A THOUSQ
l hereby certify that I ow•n property adjacent to
if
property located at
(Nnme of Property O%soer)
(Lot, Block. Road, etc-1
on , in _.._...._ .C� _ , N.C.
(��'aterbod}�) (7'os n and/or County)
He has described to me, as shwa%n belo--N, the development he is roposin at that location,
and, I ha.,,e no ob;ecttor:s to his proposal I understand that a pier/ e
must be sec back a minimmii distance of fttteen feet (i5') from my e
waived by me.
1 h th etb�c'k a uirement �OOf
109 t,wts to�tia►�e es r q JHI'1 2
1 do -.-.ish to %%aivt that setback requirement. MorahQad City 0CM
......................................... .. . ..
DESCRIPTION ANWOR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled M bY itsdividtral proposhjf development)
Cam,+
-bf:?bsrd.� 1t Do
F4,Ar/a�
Y c K
8 xrit :�
M
.I ......................_ ......... _.....I........
S� nycure
Print or Type Nance
`l Telephone Number
�— Date: _ 1 0 --- 6 k,
AA1 t'�
7

JAN 2 200fi
head CITY DCM

10
RCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary
V Q
Date
JAN 0 3 2007
Morehead City DCM
Applicant Name
Mailing Address
7
I certify that I have authorized (agent) �-� e' ��/ /-' ✓ to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
f = 1 T
install or construct (activity) v"✓� Y ; S ,
at (location) <' /
This certification 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 - 50% Recycled \ 10% Post Consumer Paper