32957_WESLEY, EDNA B_20030106

-.-CAMA / DREDGE &FILL,-'�
GENERAL PERMIT
Previous permit #
❑New C Modification ❑Complete Reissue El 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 1
❑ Rules attached.
Applicant Name Tr� ;
Address
City- State ZIP
Phone # (_) .� ..'.C: Fax # ( )
Authorized Agent /
Affected L CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
L; PWS: ❑FC:
ORW: yes / no PNA yes /' no Crit. Hab. yes / no
Type of Project/ Activity
Project Location: County ( ' _
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP -- f (' :
Phone # ( ) YRiver Basin
Adj. Wtr. Body__ nat /-an /unkn)
Closest Maj. Wtr. Body _
(Scale:K� )
Pier (dock) length E t
Platform s ---
Finger pier(s) { —�
Groin length
l
number
Bulkhead/ Riprap length —
avg distance offshore
I
max distance offshore
<,
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
I
Other r I
Shoreline Length j
SAV: not sure yes no... '
I �
.--
Sandbags: not sure yes no ; ti i
Moratorium: n/a yes no i j
Photos: yes no j
Waiver Attached: yes no
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions , 1
Agent or Applicant Printed Name
Signatures Please read compliance statement on back of permitrr
/
Application Fee(s) Check #
vyi 0
Permit Officer's Signature
Issuing�}Date f } ExllAirallon Date
Local Planning Jurisdiction Rover File Name

� 0
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, certifythat this project is consistentwith 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

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PERSONAL MONEY ORDER
MERCHANTS EXPRESS MONEY ORDER COMPANY
MFMO MONF.V ORDER COMPANY
MEMO MONEY ORDER COMPANY OF NEW YORK
PO ROX 3363 CAMP HII L PA 17001 RR63
17III 131 066-1
IRO01 922 11079
NOT VAC ID UI•RESS MACHINE IMPIIr IT L N
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ElY SIGNING. PI II , AS! .PI U�UJNI/I NONS ANO SERVICEt.NAlif �L ASSET I OTI HE PUNG'I+n iL
SIGN < E � j / // ADDRESS - LYA�' `C
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1: 103 L0L,900I:0009 16956 2 019110
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ADJACENT PARL�N PROPERTY Oi�%� R STATE�LE��I
R
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSEbEC 2 0
I hereby certify that I own property adjacent to �l�,�cZ � �Jzs lPC./ I
(Name of Property Owner)
Property located at
(Lot, Block, Road, etc.)
on 7-C•�h/ C,/� e �j , in /�eaa �e f; /� �, f�/e 4,,� f�, N.C.
(Waterbody) (Town and/or County)
He has described to me, as shlown below, the development he is propos:::_ at that location,
and, I have no objections to his proposal. I unders=d that a pierlmoor�ng
piiin_s1 aoalif`Jboathouse must be se: back a minimum distance of fiILeen fm my are=
of rpa-ian access unless waived by me.
I do nnt wish to waive the setback requirement.
I dn wish to waive r^.at setback requirement.
DESCRIPTION A.+-D/OR DRAWP G OF PROPOSED DEVELOPNIEti7:
(To be filled in by individual proposin; developrnerzr)
Sismature
/0 612 r
Print or Tvn` Name
Te!ephone Dumber
Date: D -<

ADJACEN-F RIPARL�N PROPERTY OW NTR STATEMENT ~~ ,
(FOR A PIER/MOORING PILINGSIBOATZIFTIROATHOC'SE) DEC, C1r
2 Q 2002
i
, a
(=C" i
t . FNT
I hereby cer-dfy that I own property adjacent to GL_
(Name of Property Owner)
prope:-ry located at
(Lot, Block, Road, etc.)
on
Cl/e, e in 0" /2,
(Waterbody) (Town and/or County)
He has descrioed to me, as s<<own below, the development he is propos __ at that location,
and, I have no objections to his proposal. I unders=d [f«7 a pie7;moor-mg
pi.iinas; aoatlif-Jboathcuse must be set back a minimum distance of ri�eej ftt: Fom my areal
of riparian access unless waived by me.
I do nnt wish to waiv-- the setback requirement.
I �Ln wisn to waive t-.at setback requirement.
DESCRIPTION AND/OR DRAWL;G OF PROPOSED DEVELOPNfEti7':
(To be filled ir by individual proposal; development)
S iUl"tore
klele _j-r
int or Tvc-e name
zS2-7ZY7
Te?enhone Number
Date: