47088_SIESENER, ROY_20061205

iW- 13,6
❑ CAMA / ❑ DREDGE & FILL
WGENERAL PERMIT Previous permit #_
INew ❑Modification ❑Complete Reissue Partial Reissue Date previous permit
As authorized by the State of North Carolina, Department of Environment and Natural Resources D
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rule
Applicant Name
Address
City 1': e. t f. State ZIP
Phone # O Fax # O
Authorized Agent
Affected ❑ CW ❑ EW ® PTA ❑ ES ❑ PTS
AEC(s): [IOEA ElHHF ❑ IH ❑ UBA ElN/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / nc
Project Location: County
Street Address/ State Road/ Lot #(s)
attached.
Subdivision
City ZIP
Phone # O ` zr { r River Basin
Adj. Wtr. Body i C `_ r - (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
-
I
------ -
I " S, . I
i
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
Beach Bulldpzing
y�r�
Other ' 1 a
J
C
-T--=-
-!
I
j
---
i
I
i
ty
-
Shoreline Length I
SAY: not sure yes
Sandbags: not sure yes (no
Moratorium: n/a yes �pol
Photos: ye no
Waiver Attached: no - _ _ -- - -- - __
A building permit may be required by:
Notes/ Special Conditions
_ _- _--
-
[] See note on back regarding River Basin rules.
Agent or Applicant Printed
Signature Please read compliance statement on back of permit
Application Feels) Check #
5 /�-, f.,.-t/
Permit Officer's Signature
Issuing Date Expiration Date
}(ly Svc I A
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
E; Tar - Pamlico River Basin Buffer Rules Other:
r_I 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 Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
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/ 1-888-4RCOAST
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 RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Roy Siesener 's
(Name of property owner)
Property located at 6103 Cassowary Ln. ,
(lot, block, road, etc.)
on Spring Creek , in New Bern/ Craven . N.C.
(Water body) (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/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from
my area o 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)
Foley & Foley Contractors, Inc.
Phone#: [phone]
Fax#: [phone]
64�7�� AIZZ
Signature
Print or Type Name
40299�—
Telephone Number and Date

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3f. r
0�5`
S6 jr

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to _ Roy Siesener 's
(Name of property owner)
Property located at 6103 Cassow Ln.
(lot, block, road, etc.)
on Spring Creek in . New Berm/ Craven . N.C.
(Water body) (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/boatliftiboathouse 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_
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(to he filled in by individual proposing development)
Foley & Foley Contractors, Inc.
Phone#: [phone]
Fax#: [phone]
LA,t ALA-�
Signature
W,11,C"M L-
Print or Type Name
zsz- 636
Telephone Number and Date

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ROY J. SIESENER 1058
6103 CASSOWARY LN.
NEW BERN, NC 2&%D-7172 66-19/530. NC
Date co 3102
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Bank of America
ACH RfT 053000196
For
i:053000L96i: 0023704206
Dollars n