49052_WILLIS, DOUG_20070621

❑ CAMA / ❑ DREDGE & 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 15A NCAC
L - Z/- o 1166
Pr v us permit #
D t previous permit issued
Applicant Name i ' (A ,1% I� ,TI I i e Project Location: Cc
Address t i. Street Address/ State
City r. l t` �l^,t�iAf4. �^ t `/ Statet`'I ZIP
Lot #(s) � : � N,, t^vl r
Phone # O
Fax # O
Subdivision
Authorized Agent
City
1
Pir-\ (�,A i+ ! ZIP
%
❑ CW
❑ EW El PTA ❑ ES ❑ PTS
Phone #
River Basin
Affected
❑ OEA
AEC(s):
❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
"l ! i -1P _ 'P° 1 .! I" I li
(nat /man /unkn)
El PWS:
El FC:
Vc-
1
ORW: yes / no
PNA yes / no Crit.Hab. �esl / no
Closest Maj. Win
Body .
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel
cubic yards
AA
Boat ramp
/ — - - - — - -- --_ ✓'
Boathouse) Boathft X' - --- --- , + }
(Scale: f'L' j
T-i i" i T I
Beach Bulldozi
Other
Shoreline Length
SAV: not sure yes no - -- -
Sandbags: not sure yes Cq
Moratorium: n/a yes r
Photos: yes no
Waiver Attached: �-yA no
A building permit may bbee'required by:
Notes/ Special Conditions
Agentor Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
j
See note on back regarding River Basin rules.
,J-
PermitOfficer's Signature
Issuing Date' A E Expiration Date
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, certifythatthis project is consistentwith 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Morehead City Headquarters
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

ADJACENT RIPARLAN PROPERTY OWNER STATENMN-r
(FOR A PIER/MOORING PILINGSIBOATLIFTIROATHOUSE)
I hereby cer-dfy that I own property adjacent to <; s
(Name o opertvv Owner)
prope.,y located at 4-CO-7 Oak 5f, t
(Lot, Block, Road, etc.)
on bqc, SC Ct , in bAcah tcyl C(-k N.C.
aterbody) (Town and/or C unty)
He has described to me, as shiown below, the developme i he is propos;-7 a: that location,
and, I have no objections to his proposal. I understand tl«: G pier/ mooring
piling- aoadifrlboathouse must be se= back a minimum distance of Fl".11 fir from my arm
of ripa-tan access unless waived by me..::
I do nnt wish to wa v-- the setback requirement. l�_aN t1 1 20117
.fin wish to waive that setback requirement. Mpraho;ad Oityv D M
DESCRIPTION A.'N-D/OR DRAWENG OF PROPOSED DEVELMIE\'T:
(To be filled in by individual proposing development))
on i+c' West S%de ov
all I
The r\ CAC-cx
�j 66 �° 1L
q
Signature
Print or Type N me
Teieohone Number

cjla�) LCAVA
1� Doll -7 0 C--4, k7 - s
C-
OUJ

ADJACENT RIPARLAN PROPERTY O'WiNT
ER STATENEEN
(FOR A PIER/MOORING PILINGSIBOATLIFTIROATHOUSE)
I hereby certify that I own property adjacent to s
(Name o operty Owner)
property located at 4-CCI Oak 5t ,
(Lot; Block, Road, etc.) 0(+\
on-Bq� Sq� , in N.C.
aterbodv) (Town and/or C unty)
He has described to me, as s<<own below, the development he is proposi- a_ that location,
and, I have no objections to his proposal. I undersm:1id tha: a pie:/mooring
pilings; aoadiiVboathouse must be se: back a minimum distance of ftiteen fw: fiom my area
of r'pa^ian access unless waived by me.
F
I do nnt wish to wai\.-e the setback recuiremen�. ;11P! Q 11Cio-1
✓' I Sin_ wish to waive t�.at setback recuirement. Morprid �i DGM
� _
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEVELOPNIE\'I:
(To be filled it by irzdividual proposing developmerzt)
-A l'-�t on A e, west side u�
e L kl st1�r�CA 0C
►1�I.�'� rye
�asfi l VVC5f s(A-
0
Signature
0
Print or Type Name
Telephone Numbe-
T

oo7 0 Q I-s--
✓t1 F( L
0 7z,&— r6iU -7c6 -Z

ADJACENT IR,,Yi-,�-�N PROPERTY O.WNI ER STATE_LEN-T
(FOR A PIER/MOORING PILINGSIBOATZIFT/BOATHOUS,E)
I hereby ce:-dfy that I own property adjacent to
(Name o operty Owner
prope. cy located at 1+00-7 Ock 6f • ,
(Lot; Block, Road, etc.)
on 'Boout, S c , inhda,b eDr C(ffi&.r_e_fN.C.
aterbody) (Town and/or C unty)
He has described to me, as shlown below, the development he is proposi_` that location,
and, I have no objections to his proposal. I undersmnd tha: a pier/mooring,
paEs; aoatlii boathouse must be se: back a minimum distance of FiLeZ�a fee.r (if). from my area a JJ
of ripa_'an access unless waived by me.
..,� .I
I nn wish to wai,.-e the setback reauiremeni. (J nj it I L UQ /
_1z I wish to waive r;:at setback requirement. orphead City
DESCRIPTION A.+_D/OR DRAWENG OF PROPOSED DEVELOP LENT:
(To be filled in by individual proposing developmerzr)
_ft sA-oM a bed Utt on the west Side
tie L)Jvs �r'Ct
Signature
P; int or Type Name
Telephone Numbe:

C-((x)l Oaf �J-
On �-I L
CH) —7 Z-(,o — I&M -70'*�)

r:r '
DOUG WILLIS OR D
252-726-7052 NCDL 1861 38 D. WILLIS
4007 Oak St
Morehead City, NC 28557
4140
66-21/530
BRANCH 77615
Date
Pato
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WACHOVIA
Wachovia Bank, N.A.
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For �—'
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