33129_TEMPLE, JACK_20030112

,.iCAMA / DREDGE & FILL,
GENERAL PE
RMIT Previous permit #
-New _:Modification Complete Reissue Tartial 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 C ""; ! t r p
EJ Rules attached.
Applicant Name ;k" i+kMFIC _ Project Location: County 4,'AV1reJ
Address 31� 1f w+Cj4, �i
City )nth ( We State ;Jt ZIP b 5?2
Phone # ( ) Z51. 4P 741S Fax # (Zn) 1 41 &Q3
Authorized Agent SAµE
Affected ❑ CW ❑ EW ❑ PTA ®ES Ej PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / ,no PNA yes / & Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s)
'ryv�
Subdivision
City- Sc, ►" tL
Phone # ( ),
ZIP
River Basin Aft f 4
Adj. Wtr. Body /lac Ph. k ! i J . (gnat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity mi., loci Noll "fit Z5 S, Aovt Jq p, Ma i y,, 40. If
(Scale: NLVF )
Pier (dock) length _
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Rip -rip length S�
avg distance offshore
max distance offshore J
Basin, channel
cubic yards
Boat ramp _
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length 40
SAV: not sure
yes
nd
Sandbags: not sure
yes
a4
Moratorium: n/a
yes
Aq'
Photos:
yes
no
Waiver Attached:
yes
no
A building permit may be required by: (01 .K See note on back regarding River Basin rules.
Notes/ Special Conditions All 1 ock Ott, A Ai Vt +L,, n c, mrL Vk h, 1A w ' I a
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
�c
w1v
Application Fee(s) Check #
,ur+4v-<,
Permit Officer's Signature
t-',� c 1, 9-,(3. 03
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
a

N
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 (910-395-3900) 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 / 1-888ARCOAST
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

JACK M TEMPLE 6X iZq 4839
NCDL 2150902 PH 447-8583 w �� 3 66-36/531
2365 TEMPLE PT RD Date %005
HAVELOCK, NC 28532
Pay to the /,)C 0 � f1 j 9
Order of
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�' RST CITIZ�NSustComPany
r BANK Baau7 . N C.
228551166 --'
For
L00300�:0000576964 0 0L,839 —
GUARDIAN SAFETY BLUE WBL
O('bM1r�l.�kun

DJACEN T RIPARL-�N PROPERTY OWNER STATENLENi'
(FOR A PIER/MOORING PILINGS/BOATLIFIT/BOATHOC-SF)
I hereby certify that I own property adiacent to
's
(Name of Property
prose.-y Iacated at
(Lot. Block, Road, e.c_) '
on lU?0y,e /(',` - e r in N�y�%. k(A-4rLowe) W
(Waterl�ody) �'4d4 "J, N.C.
(Town and/or County)
He has described to me, as shown below, the development he is proposi..-- L that location,
and, I have no objections to his proposal. I understand tha_ a pie:; moornQ
piiings/boatlift/boathouse must be se: back a minimum distance of iifteeri fer;c
of riparian access unless waived by me. ) from my area
I do no wish to ware the setback requirement.
I dr wish to waive t=_, "back rec uirement.
DESCRIPTION AN,DOOR DRAWE;G OF PROPOSED DEY ELOPNIE`T:
(To be Puled in by individual proposin; developmenr)
Of
s-c C° 4
Siznature
Pr int Nr Tvpe Na:;,e �—
NO 4T,`7 - -2 9215
Teiepnone �umbe-
Date:

4 .
ADJACENT RIPAR.LkN PROPERTY OWNER STATE- LMNI' (FOR A PIER/MOORING PILINGSIBOATZIFTIROATHOUSE)
I hereby ce:-tiry that I own property adiacent to Jr�c /e M l
s
(Name of Property weer)
prope..7 Iocated at
(Lot. Block, pad, etc-)
on Ae,) "Ce ler in uc Utz (.��' ✓��✓ i�r. C.
(Waterbody) (Town and/or County)
lie has desc:ioed to me, as Sown below, the developmen: he is pr000si-=7 a: L; at location,
and, I have no objections to his proposal. I understand tha: a
pierimoonn`
piLres,bcaLiivboathouse must be se. back a minimum distance o� r�iZe�n r � (�) LI my arev
or roa-:a:i access unless waived by me. y -
I do rint wish to the setbac?< re�uireme:,t.
I do wish to waive `at setback recuire.�,ent.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEtiELO `E� is
(To be�Filed i by individual propo Ong dg-;elopmen_;
c� C'rJNc rxYc
�Wlve -
Pa.rt or v��
qlg -
Te!,-^non`
D-�. 1 _5 03