48195_SHEPER, RICK & BAUMGARDNER, PAM_20070321

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New [-]Modification El Complete Reissue El Partial Reissue
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
Previo s permit #
Date revious permit issued
Applicant Name- Project Location: County
Address—
ty 1 `l D l�;� �� y Street Address/ State Road/ Lot #(s)
Ci �. e s State ,' i .. ZI Fk
Phone # ( ) .5 i GI 7 7+r° Fax # ( ) Subdivision
Authorized Agent & 0� ^ oCity ZIP
Affected ElCW ❑ EW ElPTA ElES ElPTS Phone # O River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (naf /man /unkn�
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift I i
Beach Bulldozing p— -
Other Z
Shoreline Length
SAV: not sure yes n —_
Sandbags: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale: )
f
v
See note on back regarding River Basin rules.
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Issuing Date Expiration Date
, t C! ,y(-y �/ (- 0 Vi A
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
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
2S2-264-3901
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

Mar 29 07 02:40p
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Mar 78 07 11 57a
252-745-4253
SCEPER AND ASSOC
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Signaturc
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Mar 29 07 02:40p 252-745-4253 p.3
ADJACENT. RIPARUN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORrNG PiLINGSIBOA TLIFT/.80AT HOUSE)
�-
I hereby certify that I own property adjacent to Pam Z is
(Name of Property Owner)
property located at {11 j # L 0�t
(Lot, $loe Road, etc.)
on in N.C.
(Waterbody) (Town and/or ounty)
He has described to me, as sown below, the development he is proposing at that location,
and, I have no objections to his propgsal. I understand that a pierlmooring pdings/boadifflboathouse
must he set -back a minimum-disiagce-of fifteen -feet (i 5) from my- area of -riparian access unless -
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: +
(To be filled in by individual proposing development)
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1
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Signature
! � -,r y �L-'�✓cat
Print or Type Name
2sz- G3-2- i[F3/
Telepbone Number
Date- 3 ! 4-7/0-7

Mar 29 07 02:41p 252-745-4253 p.4
ADJACENT. RIPARIAN PROPERTY OWNER STATEMENT
(FOP A PMAIAIOOPING PILIIVGSBO T IFS OATT OUSE)
P,T
I hereby certify that I own property adjacent to Pam is
(Name of Property Owner)
property located at e 't SUP? Ru4 — / — v
(Lot, Block, Road, etc.) `
on� N.C.
(Waterbody) (Town and/or aunty}
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/boatlift/boathouse
must be set back a minimum distance of fifteen feet (I S} from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement_
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
{To be filled in by individual proposing development)
T -
signatLlI
Print or Type Name
06go I.v CA5
P I- A - -d 'a
Telephone Number A
Date: 3.2.1 ',j

5019
BROAD CREEK CONSTRUCTION 66-112/531
BRANCH 01901
PH.252-745-4252
11 CREEKVIEW CT
MERRITT, NC 28556-9572
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