49712_WILLIS, WESTON_20070710 (2)

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D CAMA / F-1 DREDGE & FILL 4 9712 C
GENERAL PERMIT Previous
per t #
�Nevv DModification LIComplete Reissue ElPartial Reissu Date previ s ermit issued
J - J
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
E Rules attached.
4
Applicant Name f-1 j Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State zip
Phone #(` Fax # Subdivision
Authorized Agent City qF-& "'A ZIP
El Cw El EW [I PTA El ES E-1 PTS Phone# River Basin Affected El OEA El HHF D lH El UBA [I N/A
AEC(s): Adj. Wtr. Body (nit /man /unkn
D Pws: 11 FC:
ORW: yes / no PNA yes / no Crit.Hab. yes no Closest Maj. Wtr. Body
Type of Project/ Activity \I
(Scale: Af 775
Pier (dock) length N
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel. I
cubic yards
Boat ramp
y.
Boathouse/ Boatlift—
f
Beach Bulldozing
1
1 POT
Other
I
Shoreline Length
SAV: not sure yes no
L
Sandbags: not sure yes
Moratorium: n/a yes
Photos: yes 6-01
Waiver Attached: 'y—eil no
A building permit may be required by:
❑ See note on
back regarding River Basin rules.
Notes/ Special Conditions
Agent or,Appli6n-t. Printed Name
Signature Please read-&;mpliance statement on back of per, mit,**,
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date' Ex irabon Date
r--r
APJ , I n [:�� A
Local Planning jurisdiction Rove Filb 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
landowners).
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 Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

11 (FOR A pIF.RIMOORING FILING-NIDUA I LIP //0V/I R Al"
s i
reby certify that I own pre•3erty adjaccnt to
AL9�—
(Name of Property owner)
.= i 1ai�dic
y
1 at 1 `1 l
(Street Address, Lot, Block, Road, etc.) G
in � � fe2 C Iti%� , N.C.
L—Lv- ('Town and/or County)
rbody)
has described to me, as shown below, the development he/she "is proposing at that
i have no objections to thi ipnoroum distance of fifteen feet (15') fromthat a emy area of
(boathouse must be set back a mns
unless waived by me. I have indicated my intentions by initiating below:
I do ug, agree to waive the 15' setback requirement.
I'do agree to waive the 15' setback requircuient.
l
l
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APR 02,2007 11:30A
PTION AND/OR DRAWING OVPPROPOSED DEVELOPMENT:
(To be died in by individual proposing development)
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42
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' 2700 lOc� C
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-------------------
Signature I
Print or Type Name
Telephone Number I
Date: "� I
page 1
2527266079

�DJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIROA7'Il4USL)
il �reby certify that I own property adjacent to ! �'� f ¢! �+- '��I*v s
(Name of Property Owner)
wap"Lted at 1 171- 1 1 2 G��>gr- �� I (RI v d—
(Street Address, Lot, Block, Road, etc.)
l�-k-- -, in C-� ! l�% , N.C.
Waterbodv) (Town and/or County)
on
r
APR 02,2007
has described to me, as shown below, the development he/she 'is proposing at that
I have no objections to this .proposal. I understand that a pier/mooring
(boathouse must be set back a minimum distance of fifteen feet (1 S) from my area of
unless waived by me. I have indicated my intentions by initialing below:
ldo goagree to waive the 15' setback riquirement.
II do agree to waive the 1 S' setback requirement.
--- ---------------------------- ---------
;RIPTION AND/OR DRAWING 01rPROPOSED DEVELOPMENT:
(To be rlted b by individsMl proposing development)
rj"O
11.30A
T,gnatu—re
0vJ -s
Print or Type Name
Telephone �Number
mber Date: �7 —,� i
2527266079
page 1

i ! (FOR A PIF.Mf00RING PILING ,YIB"R I Lir Iiuv/+ I )Fllia,01"
fy � reby
certify that I own property adjacent to / L iv /=�,i��3 e
(Name of Property Owner)
Lted at 6
I(Street Address, Lot, Block, Road, etc.)
in C �-�� �1 I% N.C.
on (Town and/or County) l
aterbody) I
i, the development he/she 'is proposing at that
she has described to me, as shown below, I
' "• • j have no objections to this proposal. I understand that a pier/mooring
Ioe� $/boathouse must be set back a minimum distance of fifteen feel (I 5') from my Area of i
unless waived by me I have indicated my intentions by initiating below:
� I
i 140
agree to waive the 15, setback requirement.
I do agrea to waive the 15, setback mquirdinent. I
------------------------------ ......... i
ON AND/OR DRAWING OJ PROPOSED DEVELOPMENT: i
ARI(To be rued in by individual �`�oposing development) ,' r� G
I
�` -� __--- r-------------------
_- I
signature
�jva-rI4 r�©
l Print or ype Name
Telephone Number I
-C w / Date: (�
page 1
2527266079
APR 02,2007 11:30A

DR. W. ALEX WILLIS
NANCY M. WILLIS ss 3ofs31
252-393-8344 080 2837
531 DEER CREEK DR.
CAPE CARTERET, NC 28584 /y
DATE _ _( � �_
PAY TO OF
ORDER OF w
--- - --- r $ 14(00, 0 0
t 41n and Ilnnwi k. I usl GUr 'ns Bank logo on back. If nol pmsenl. du not cash.
DOLLARS � MZ.—
Ila# CITIZENs BANK Cle to f�f
,:0 5 3 100 300j:000 76 7 1 79066n' O 2FL