61038_JACKSON, JERRY_20120814

NO. 61038
DCAMA J C DREDGE & FILL
GENERAL PERMIT
Previous permit #
DNew ❑Modification CComplete Reissue
❑Partial Reissue Date previous permit issued
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
❑ Rules attached.
Applicant Name
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
City State_ .. ZIP
Phone # (_ _) Fax # ( )
Subdivision
Authorized Agent
City_ ZIP
Affected a CW ❑ EW O PTA ❑ ES I PTS
Phone # (___) `G7�Fi" River Basin
AEC(s): C1 OEA D HHF D IH C, UBA ❑ N/A
-1
Adj. Wtr. Body-- _ (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
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel " 4 "A' t
cubic yards 770,
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other_ _
Shoreline Length '
SAV: not sure yes no
Sandbags: not sure yes no j
Moratorium: n/a yes no
I�
(Scale: ¢ o �� ) I
_{ L-
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Ail
— I
6-
Photos: yes no
1—
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 #
—.Rai
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date
Local Planning Jurisdiction
Expiration Date
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 I) 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 howto complywith 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)

30

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Aria
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NC
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date Ca -
Name of Property Owner Applying for Permit: '104
Mailing Address: ®��I:y rT,
1-170 5 efi �r
26 �'k
I certify that I have authorized (agent) �t ` k I ` to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
f
at (my property located at)
This certification is valid thru (date) UN if + c O.
re
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at L/c--� 76 5Slane ./fir, ,
(Lot, Block, Road, etc.)
on tIRA, , in N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 2 ' 2(9 5- 20qo Mailing Address: `y ZO 52,f 5 1) R-
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
----------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
��Ai�Z)o OQ-/-[) ?-P�* 'I N� ^TrA6 eL
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature
City/State/Zip
25-'Z- 26 � - ZN9
Telephone Number
Signature Date
I� 1 �hctr e1 E"s 1 4fq m � 1+cy, •� r
Print or Type Name
zrZ- zzf -a-?v to
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent t �SL 's
(Name f Property Owner)
property located at \ l D JV `� V� T) r
(Lot, Block, Road, etc.)
on
V ��lt ( , inL L I , N.C.
(Waterbody) Qp (Town and/or County
Applicant's phone #- l d - OS Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
C- kcLu,,
(Information for Property Owner Applying
for Permit)
0 S cv16 4oaL;- VP --
Mailing Address
M-L4-7,T 6 L I\1 C'
City/State/Zip
C2552- .26q- ZB��
Tel e Number
1W1JJ,6aJ,
SiEffre Date
(Riparian operty caner formation)
Signature
S��-- 4 ?0-0t� 75��PS �� a
Print or Type Name
Telephone Number
9'--&- 1 Z
Date

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