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,❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT e�
Previous permit #
[-]New ❑Modification []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 I SA NCAC
Q Rules attached.
Applicant Name
Address
City State ZIP
Phone # (i ). ? `' %' %t� Fax # ( )
Authorized Agent C
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes /,no PNA yes / no Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body i (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length
I � i
Platforms _' _ — - - ---- — — - - _ -
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp-
Boathouse/ Boatlift
go
I I
1
i
-
(
I
y
'
Beach Bulldozing
Other
I
I
I
Shoreline Lengths
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
_--
I
j
l
i
t
I
I
i►'
1
-
!
---I -
❑ See note
on back regarding
River
Basin
rules.
Agent or Applicant Printed Name
k0 � It l i �'1 /1
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
(' .{ r- \ r.t, C.' M 0(030 / to
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:
❑ 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: 252-264-3723
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax:919-733-1495
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-13 Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: 252-247-3330
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax:910-350-2004
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01
=II
PAY
TO THE
ORDER OF
- (] 5_a_ a u r t 1 e n h a n c e d
COASTAL MARINE CONTRACTORS INC
PH. 252-638-6407
PO BOX 12729
NEW BERN, NC 28561-2729
D C�
% 1JZ%
DATE
66-112/531
e 3 01901
u� da
i$
_DOLLARS B ,
BB"
BRANCH BANKING AND TRUST COMPANY
NEW BERN NORTH CAROLINA
FOR
u'006868ll' �:�53 LO L L 2 L�:S 1 l0 1 1 2698ii' �az
- -
%. V..I• � •A. AkiAr.Vl/1IJlIV J I(JIlYUJ/DVri4LIt'I/DVPlli1VCJJr)
I hereby ce:-dfy that I own property adjacent to :0eve, S'd�5 's
(Name of Property Owner)
property located at
(Lot; Block, Road, etc.)
on rc° N� �l �2� , in Tra_ i l W o0 C/15 �-ra %f,h%
(Waterbodv) N.C.
(Town and/or Cout
He has descrioed to me, as s1hown below, the deve?opment he is proposing at that location,
and, I have no objections to his proposal. I understand that a pie:/mooring
piiings/boa1iVboathouse must be se: back a minimum distance of Freea feet (15') from my area
of ricess unless waived by me.
I do not wish to wa:,.-e the setback recuireme;it.
I d-Q wish to waive ti�at setback recuirement.
DESCRIPTION AND/OR DRAWS G OF PROPOSED DEVELOPWEYT:
(To be fzZled in b_v individual proposing development) oak W ,{k . �
5 4
Te!e:)none Number
Dace: i"lt"X-
%. ....... aAry a aa_IVkJJ/UV/-L![-/l'I/DU'AiIrJULIJGJ
I hereby certify that I own property adjacent to S4e—U's
(Name of Property Owner)
property located at � /Z 11//e„ �1,
(Lot, Block, Road, etc.)
on euf �� U�r% , in rekllGc%00� 1ef-,4t1e,4J
(Waterbody) , N.C.
(Town and/or ounty)
He has described to me, as shown below, the deve?opment he is proposing at that Iocation,
and, I have no objections to his proposal_ I understand that a pier/mooring
pilings/boa-liffboathouse must be se: back a minimum distance of fifteen feet (I5') from my area
of riparian access unless waived by me.
I do not wish to wave the setback requirement.
I d-Q wish to waive teat setback recuire.;,eat.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEVELOPNIENT:
(To be filled in by individual proposing development)
per hec�l�ns�
4AOH
1st«9
u(Khe
S iRnature
Print or Type Dame
Te!ephone Numbe;
Date: