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DCAMA / ❑ DREDGE & FILL
�:. 32913 -c
IV At
GENERAL PERMIT
�
Previous permit #
17New ❑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 I SA NCAC
Rules attached.
Applicant Name AO uat, Vic ij r 4 ly f
Project Location: County
Address—tj �cw�� �Gh.+c�• 9. vE
Street Address/
State Road/ Lot #(s)
City k p State 1A ZIP
Phone # (� �9) r t- 53E 1 Fax # ( )
Subdivision
Authorized Agent f d J
City %j -lull '
�'yc( ZIP l S/ Z
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # (
) River Basin Le K
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
wt, r. nnvd s !a nv(nat /fnari /unkn)
❑ PWS: ❑ FC:
`
ORW: yes / no PNA yes / ' Crit. Hab. yes / no
Closest Maj. Wtr.
Body N'` %� v "'
Type of Project/ Activity TV',R-1 CP W
(Scale: N;:a; C )
Pier (dock) length
.... 1__ _
Platform(s) — . 1._... I --—---j---
Finger pier(s) _C
Groin length G
number
T_i I
Bulkhead/ Riprap length_ _
avg distance offshore
-
max distance offshore k
Basin, channel
cubic yards -I —
161-Boat ramp
Boathouse/ Boatl ! _
LiBeach Bulldozing ! --- - L --
Other � -
—
�_ E
Shoreline Length YI r fi
SAM not sure yes no
Sandbags: not sure yes o — ti Q I I
i
P �— 11 t,
/ Y
Moratorium: n a es ho`
Photos: yes ;no-T
Waiver Attached: yes 09
di -- -
A building permit may be required by: 1611k �. 9#d a- ❑ See note
// on back regarding River Basin rules.
Notes/
�Special Conditions All W(°y Mud & ru-!; d cy N-A -?Jig, It /Tc! dak rt
'ttr-�(i•"t�� l� Ne ��'! Fdli fr. � ►f f'fp! t.�'}t"5• 3°�.
or Applicant Printed Name
Signature Please read compliance statement on backof permit's
Application Fee(s) Check #
-&�J. f44U14,
Permit Officer's Signature
�t E
j
Issuing Date
Expiration Date
A+!tl wt EAar
J �dr� 5 ► �
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 [)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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules D 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 complywith 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: 919-733-1495
Fax: 252-264-3723
(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: 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
ERIC B. ELLIS NCDL 65047
JASA M. ELLIS PH (252) 726-6775
205 NOTTINGHAM DR.
MOREHEAD CITY, NC 28557
2328
/ 66-30/133
Date
Pay to the �J� f�
Order of / C v 1 $ / d 0i 06
CJ/✓ �" /l j t✓�f r� a/ a p o Lars 8 'EE E -,
FIRST 01CITIZBE—NSR.— t
BANKr s cin:a-us h, N. a 2851 comRaRy
lY' Aua dic Baach, N.C. 28512
For�9/-3L �A�a.✓ �i�
I:0 S 3 L00 300l:00 L 3 L 7 L, 48 7801I' 0 2 3 2B
GUAROIAN®SAFE" BLUE ESBL
1"W"m P.O. Box 27751
Raleigh, NC 27611
ww1-888-840-6500
North Carolina
w.NCAAHPERD.org
Support Friends & Jump/Hoops for Heart
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NCAAHPERD 2002 Convention: Nov. 20-23
"w?ov~'a is the erf
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
.- , /
I hereby certify 'that I own property adjacent to � , {Ta�v �,¢ �t GUIf/�
(Name Property Owner)
property located at 613
f / Gt, C C&�L�X-
��
l
% (Lot, Block, Roo�ad, etc.) %
on �/� ( , in _�/'7 7 /.*/L/ 4r C
(Waterbody) (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. I understand that a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement. NOV 0 4 2002
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMF.ENT:
(To be filled in by individual proposing development)
Print or Type ame
Telephone Number
Date: 1 Q 9 "d
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify 'that I own property adjacent to // � i`rE�`+� � s
(Name of Pr rty Owner)
property located at
(Lot, Block, Road, etc.)
on �i/�i� in _7l�/11''T►`c , N.C.
(Waterbody) (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. I understand that a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waiveddbby me.
y I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
-----------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPP-TENT:
(To be filled in by individual proposing development)
&10
•
PP
Signa re
S 64 tiI�
Print or Type Name
Telephone Number
Date: / jam-