49782_TRIPLETT, DENNIS_20070725

r] - 2 C-o -1 45-16
❑CAMA / ❑ DREQGE & FILL
r. GENERAL PERMIT
❑New ❑Modification ❑Complete Reissue []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 I SA NCAC_
w
Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name .'( 1 �. Project Location: County
Address T i i 1 I ^i XP C' 1- Street Address/ State Road/ Lot #(s)
Ci -) ��� 1 State ZIP /�C'`
Phone # ( L)C'0, Fax # (_) Subdivision
Authorized Agent City -"� ZIP
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # O ~'f "� River Basin
Affected ❑ OEA ElHHF ❑ IH ❑ UBA ❑ N/A
AEC(s}: Adj. Wtr. Bod(nat /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 J
Platform(s)
IV)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap 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
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
i
5
(SFale: r ram.
�J
Ell See note on back regarding River Basin rules.
PermiOfficer's Signature
Issuing Date Expiration Date
Local Planningf urisdiction 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:
4ar- Pamlico River Basin Buffer Rules ElOther:
euse 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 ar the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Offi (252-946-6481 the Wilmington
Regional Office (910-796-7215) for more information on howto complywith these buffer ru es.
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 Headauarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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

ADJACFNF RIPARIAN PROPERTY OWNER STATOVMYf
hereby certify that I own property adjacent. to DEA) tJ x,1 " , A F, -r " is
(Name of Property Owner)
property located at L a _-r R ---1
(Lot, Block, Road, etc.)
ff aterhody) (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 bis proposal. I understand that a pier/mooring
pilings/boadift/boathouse must be set back a minimum distance of fifteen feet (15' ) from zny area
of riparian access unless waivers by me.
-0
I do uqt wish to waive the setback requirement.
I do wish to waive that setback requirement_
DESCR.EMON AND/OR, DRAWING OF PROPOSED DREVELI}I'NMNT:
(To be filled in by individurd proposing development)
5c A.k
llco"- 'e
nature
Print or Type Name
Telephone Number
Date: µ

ADJACENT RIPARIAN FROPERTY OWNER S'I'ATUUWf
I hereby certify that I own property adjacent to J/+eJl} tJ 5-1
(Name of Property Owner)
property located at " p'E e2 d lo; T Q �y sr k) De, -
(Lot, Block, Road, etc.)
ff aterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that
IGcation, and, I have no objections to his proposal. I understand that a pierIRlooririg
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (ls') from my area
of rip ian access unless waived by me.
I do not wish to waive the setback requirement.
1 do wish to waive that setback requirement.
DESCIUP `ION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fallen in by indivedurd proposing development)
t
W A'T6 P- 041N ►
Print or Type Name
2S; z -Sys - V 104
Telephone Number
Date:

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