33655_RUKENBROD, DEREK_20030311

• ;.�-1CAMA / n DREDGE & FILL
GENERAL PERMIT
Previous permit #
New CModification _]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 'J
❑ Rules attached.
Applicant Name ) V 14'f�-, �r ctJ Project Location: County fn- I, i
Address LPN;, 110fa4 Lone
City_ V o, is He State Ak ZIP
Phone # ( -7 )17L5 - � a �f Y FaX # ( -/°'�)
Authorized Agent
CW EW � PTA El ES ❑ PTS
Affected
AEC(s): OEA I—HHF ❑ IH ❑ UBA ❑ N/A
PWS: ❑FC:
ORW: yes /._9 PNA yes / no Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision/• -
City ZIP Y rt z
Phone # ( ) — River Basin
Adj. Wtr. Body //� %N t,a to �n t /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: i✓� •�F )
Pier (dock) length
Platform(s) X7,
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
--�—
j
i
f
'yt
jM
r
I
I
1
'
Shoreline Length.__
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no j
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
_
I
I
I
j
j
back regarding River
See
note
on
Basin
rules.
Agent or Applicant Printed Name Permit Officer's Signature
Signature "Please read compliance statement on back of permit" Issuing Date Expiration Date
�11C�.Gor A, Ir,
Application Fee(s) Check # 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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
F 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / I-888-4RCOAST
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

JAMES A. PIVER, JR. NCDL 1507942
JO PIVER NCDL 355390
PH 252-728-5678
144 HOWLAND PARKWAY
BEAUFORT, NC 28516
PAY TO
ORDER
1561
66-763/531 CLS
DArc
l D D i
oeiene ee
DOLLARS
ETA_
Wachovia Bank, N.A.
Raleigh, NC 27609-5757NP
FOR 5 6 L
6266 5
I:053L076331: 7►+3�� L
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ADJACENT RIPARLAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIROATZIFT/BOATHOUSE)
J'_- S a� o
per�lC
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at z Gi k : fe k'f - �
(Lot, Block, Road, etc_)
on in 5ief I �� C'�l�-fIfre t Cam;. , N.C.
(Waterbody) (Town an/or County)
He has desc- ed to me, as s<<own below, the deve'.opme:,t he is proposi: 7 a: Chat location,
and, I have no objections to his proposal. I ur,de=d tha, a pie./mooring
pIn2s� aoadifftoathouse must be se: back a minimum distance of f.i�=i fe:.: (1-5') from my area
of rpa_ian access unless waived by me.
I dn Tint wish to wane the setback requirement.
I �Ln wish to waive t:.at setback recuirement.
DESCRIPTION AND/OR DRAWL�G OF PROPOSED DEVELOP`IE\_T:
(To be.)UZed ir, by individucl proposzn; developmenr)
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Print or Type Name
Te!eonone Numbe-

,- DJACEINT RIPARL- .N PROPERTY OWINER STATE_LENT
(FOR A PIER/MOORING PILINGSIBOAT L TIROATHOUSE) I C
a � I o
lereby cer-dfy that I own property adjacent to pe } e,r (ilGc i, t er 's
(Name of Property Owner)
prope, �y located at (j k : fe
(Lot, Block, Road, etc_)
on NaA"Clf creek , in .51e- 1 C-i ere f C,-, . N.C.
(Waterbody) (Town an/or County)
He has described to me, as sIL hown below, the development he is pr000s -_ a_ t`at location,
and, I have no objections to his proposal. I undie=d tha: a pie:/moor;IC
piiirs:s;coadifL/boathouse must be s , back a minimum distance of fii�een f:z: (15') from my area
of nioa_ia, access unless waived by me.
A,--- I dn nnt wish to wa:vz the setback reoulreme:11.
K a-
`�¢'•` I fin, wish to waive t.at setback recuire; chi.
DESCRIPTION Ati-D/OR DRAWLNG OF PROPOSED DEVELOPNIE`-I:
(To be filled in by irzdividual proposing development)
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Pint or Type Name
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Telephone Number