34550_SANCHEZ, WARREN_20030728

P01CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
RM I Previous permit #
k❑New ❑Modification El 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 12 CO
'_J tt 21 Rules attached.
Applicant Name r"-+r' u r t h e Project Location: County (/2r J01 1
Address is ' t Street Address/ State Road/ Lot #(s)
City i''Pu I.! 4di State �JC ZIP
Phone # (1(2) '77t - 7 Q6 Fax # ( ) Subdivision ^> !J rlelF !,
Authorized Agent �r o, !� City 't `r'd 144 c A ZIP S1
Affected ❑ CW fn EW 21PTA ❑ ES ❑ PTS Phone # River Basin Al J' FC
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body l v n,4 A4 61 ; i Pr /L na /man /unkn)
❑ PWS: ❑ FC: 1
Agent or Applicant Printed Name
Signature "Mease read compliance statement on back of permit
j, is 4 n
Application Fee(s) Check #
l41 6h.t,
Permit Officer's Signature
T 7J-f 3 ti -? c3
Issuing Date Expiration Date
L 7-
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:
[p 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 / 1-888-4RCOAST
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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HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK {
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1028105 -- -- - ---- -- - - ----
Pay To The Order Of tit
HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK
V' 278212571 10-86/220
8I/16/2003
Dollars
*ONE HUNDRED DOLLARS AND 00 CENTS $*************100.00
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Addr -
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WACHOVIA
Issued by Integrated Payment Systems Inc.. Englewood, Colorado / ^�+ 2eCJl7O
To Citibank (New York State). Uulfalo, N.Y. C7T V J �
Not Good For More Than $1,000.00
III 3S092711' i:0220008681: 6800271B2L2S7LLill

JUL-10-2003 THU 11:22 AM NO DIV OF COASTAL MGMNT FAX NO, 4 P, 03
ADJACENT R011ARIAN 11110PERTY OWNER STAT!?MEN'1'
(1,01Z f4 R,f'ERIifOORING PILfNGSI,80AI'LIFT/B'OAT"OUSL')
I hcrohy coeffy that I owls property adjacent to
(Name of Property Owner)
(
)toperty located at 1 I>Li
(Lot, Iilock, Road, etc.)
' � N.C.
oil..,.. - _
(Waterbody) (Tolv►i an otiuty)
He has described to ane, as sizown below, the development he is proposing at that location.,
aa)d, I have no objections to his }proposal. I understand that spier/moeringpilings/boatlift/boathouso
must be set back a rriniuiuni distance of fifteen feet (15') from Lny area of riparian access tnil3ss
waived b nc.
- I do not wish to waive the setback requiren-ient.
T, do wish to waive that seti)acic requirement.
------- -.,.
---------------,
IIESC.1tII'TI{)ti A _ .
ND/Olt DRAWING OF PROPOSED DEVELOPINIFNT:
('I'a befULed in by it, itivirhtat proposing development)
51gnaiurc
i� t; 14 ovr %
Print or Type Name
elepitone Number
3�

JUL-10-2003 THU 11:21 AM NO DIV OF CCASTAL MGMNi FAX N0, 4 P. 02
Z003
DIVISION OF COASTAL MANAGEMENT
AI'.yJACENT RIPARIAN PROPERTY OWNER NOTIFICAT� 1WAIVER FORM
Name of Individual applying for Perlttit,-��
x , F— 67y
z—
Address of Property: r'�
57
(Lot or Strait #, Sircet or Road, City & County)
I hcrt:b y certify that f ownr�roperty adjacent to the above referenced property. The individ it
.1pplying for this permit has described to me as shown on the attached drawing the developrr
they are proposing. A description or drawing, with dimensio. s, should be provided with this
letter,
I havc no objections to this proposal,
If you have objectio)zs io Wiat is being proposed, please write the Division of Coastal
Afartagement, Hest"O Plan t o tr is�zjotice, iVo response ehead City, � 28557 or l
nse is considered the same as no obje tton
80S wrthiei 10 days Of rece p f
if you have been nr;gftetl by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, moo; in`; }pilings, breakwater, beat house, lift or sandbags must be
set back a rnininurm distance of 15' frort) my area of riparian access unless waived by mo. (if you
wish to waive the setback, you must initial the appropriate blank be'ow,)
I do wish to waive the 15' setback requirement.
_ I rto tint wish to waive the 15' setbarlk requirement.
�rnd-c t X"k, ,, � - ZZ — 03
Date
Print Nartte
Teicphone Number With Area Code