33102_PRUZAN, MAX_20030109

CAMA 1 ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #"I'
C]New LModification ❑Complete 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 r'Ie A II i+I ae
Address !L? Wo4,, fort
City tJpWPer"f State f.i! ZIP 1g5770
Phone#(_sz)72k'81t.2 Fax#()
Authorized Agent fir,
Affected CW ❑ EW QPTA DES D PTS
AEC(s): '- OEA Ell HHF ❑ 11H ❑ USA ❑ N/A
V PWS: ❑FC:
ORW: yes / no PNA yes / 1 o Crit. Hab. yes / no
Project Location: County icy 4i s #
Street Address/ State Road/ Lot #(s)
127 1,64" lone Vr! 5.1" Jil 14 i! 0 71.`u
Subdivision )f0 0 t
City`+lZIP
Phone # O River Basin :,il.,
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Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Y0004 C-dj''
Application Fee(s) Check #
Permit Officer's Signature
17 t3
Issuing Date Expiration Date
('e'4e +.; ('T^ij'9 J,A
Local Planningfurisdiction 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:
❑ 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent toy,�l/_ �- _ ,s
(Name of operty owner)
property located at
(Lot, Block, Road, etc.)
onspga&e_ in , N,C,
(aterbody) (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 his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To he filled in by individual proposing development)
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Signature
WIT/ -)Ae4l'
P -"Tam
Print or Type Name
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Telephone Number
Date;

O1/08/03 WED 05:38 FAX [phone] Hatu Pro(Juce
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I hereby certify that I owt4 properly ad';acent !a
( ama of pay Ownkr)�
plgpctty iocated at
(Lnt, Block, iioa-J, tic.)
on in _
( atKrboaY) {Town: and/or Cofor'll
He hpA descAbed to me as %"wn bCow, j1e development he is prOposing at thu location.
and, I haYC no objections to his propasal.
IDESCQttPFtOY a►N1Dlt it bRAWUff (,, 01, pgopGSEU 17EVE1OPMENT
(ro bs filkrd in by iR1ivOR21 P-Pp)sing develop►nenl)
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rint or'Type Namc
719 7 _ -;�L1�
Telepho" Number
fats: 7 r G o
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