59702_JONES, RICHARD_20111228

�-. ❑ CAMA / ❑ DREDGE & FILL j.
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_
Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name t � ` i - 11 Project Location: County
Address rs "N jti Street Address/ State Road/ Lot #(s)
City State/W ZIP A
Phone # O Fax # () Subdivision
i
S
Authorized Agent' _ r " City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # O River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑FO
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platt
Fing
Groi
Bulk
Basir
Boat
Boat
Beac
Oth4
Shor
SAV.
Sand
Mon
Phot
Wain
(Scale: )
o
rm(s)
er pier(s)
n length
number
iead/ Riprap length / '•
avg distance offshore_
max distance offshore i t
,channel _—
i
cubic yards I /15 r 0 14 7-,'T
ramp
louse/ Boatlift
i Bulldozing -
I I
r i
I i I
U
dine Length
not sure yes C�no1
gags: not sure yes (n i
torium: n/a yes i" nro
Ds: yes 'no
er Attached: vas no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read cGInP, ce5tatemeni on back of permit
Application Feels) Check #
❑ See note on back regarding River Basin rules.
PermitOffiSer's Sig ture "'
Issuing Date Ex iraticn Date
i�
Local Planning Jurisdiction Rover File Name
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read cGInP, ce5tatemeni on back of permit
Application Feels) Check #
❑ See note on back regarding River Basin rules.
PermitOffiSer's Sig ture "'
Issuing Date Ex iraticn Date
i�
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 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 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

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NCDENR
Not Cl,,:rolina [►epartment )f Environment ind Natural F,esources
)ivision of Coastal Manac ement
Beverly Eaves Perdue, Govan for
James 11. Gregson, Direc ' or i )ee Freeman, Secretary
Date,
__J .' C'�:�i
IApplicant Name �`—
�
Mailing Address
6W <-� LC
to act on nny
I certify that I have uuthori zed (agent).:�CL
behalf; for the spurj],Ise of a plying for ttnd obtaining �! I. AMA Permits necessary to
install or c onst-ruci actiViV,}
t ovation /!�0
This certification i!, YA" t °r� (date)
Signature
400 Crrpimerce Avei it le, Morehead Cii ,, , North Caroline 28557
Phon5�F!: 2:a •BOKE GB 1 FAX: [phone] lntern : t: www.ncco�Istalmanagement.net
An f:: a ial oppor'u wty 1 Affirmative Action Employer — 50% ;:cycled 110% Past -onsumer Pbper

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