33618_WALLACE, JERRY_20030221

El CAMA / P DREDGE & FILL
GENERAL PERMIT
-]New E Modification 1—Complete Reissue EPartial Reissue
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_
Pr vious Date previous permit issued
is
Applicant Name Project Location: County
Address—, \441-LA1
City i -:)j— State ZIP
Phone # Fax #
7
El Rules attached.
Street Address/ State Road/ Lot #(s)
Subdivision
Authorized Agent
J"
City
CW
❑ EW F! PTA
_❑ ES 0 PTS
Phone #
Affected
I OEA
AEC(s):
CI HHF --1 IH
I— UBA El N/A
Adj. Wtr. Body
El PWS:
FC:
Closest Maj. Wtr. Body --
ORW: 69 /' no
PINA yes no
Crit. Hab. yes no
ZIP
River Basin
(nat /man /unkn
Type of Project/ Activity
(Scale:
Pier (dock) length__
Platform(s)
--T
Permit
Signature
Issuing bate
Local
Rover File Name
Ad P ' Name
�entorA�ppp jcpt rint 1*
Signaturek Pl4ase read compliance statement on back of permit"
Application Fee(s) Check #
Officer's
Planning Jurisdiction
it #
piration Date
Ad P ' Name
�entorA�ppp jcpt rint 1*
Signaturek Pl4ase read compliance statement on back of permit"
Application Fee(s) Check #
Officer's
Planning Jurisdiction
it #
piration Date

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 U Other:
D 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 (252-946-648 [)or the Wilmington
Regional Office (9 I 0-395-3900) 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 / 1-888ARCOAST
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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ADJACENT RIPARL N PROPERTY OWNER STA.TEMENI T
(FOR A PIER/MOORING PILINGSIBOA TLIFTIBOA THOUSE)
I hereby certify that I own property adjacent to )e-'eyvl wct�`QG�
5
(Name of Property Owner)
property located aty� F
CL—
(Lot, Block, Road, etc-4
�C , in �e^
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/mooring
pilings/boadift/boathouse must be se: 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.
I I4 wish to waive ti:at setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPME-N-1:
(To be filled in by individual proposing development)
e •
Signature
JA2IP1,577 G STArGq—M0n-7-F_of
Print or Type Name
Vo -3Z& --351Z
Telephone Number
Date: _ 2 — i S', D 3

FROM : STEVE BARTLEY FAX NO. 9103472662 Feb. 19 2003 09:46AN P1
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