55011_UPCHURCH, ROBERT_20091023

❑ CAMA / ❑ DREDGE & FILL
GENE~ L" PERMIT Q%� � Previous permit #
_tIew edification El Complete Reissue ❑Partial Reissue C�//// Date previous permit issued
As authorized by thiAt t90 rth Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Aales�atta jhed.
Applicant Name I� Project Location: County
Address Jc
Street Address/ State Road/ Lot #(s)
City /-Y)State ZIP / l l"+ice( l "�
Phone # (.}� —� tFax # ( ) Subdivision ---� -
Authorized Agent City zip
Affected aCW [ V L�PTA ❑ES ❑PTS Phone # ( ) ` �^ (AlRiver Basin ; , I i (/
❑ OEA ElHHF ElIH ❑ UBA ElN/A
AEC(s): El PWS: ❑ FC: Adj. Wtr. Body A.e '� j( (nat /man /unkn)
ORW: yes / rno PNA yes / :no i Crit.Hab. yes / no Closest Maj. Wtr. Body Ij7
Type of Project/ Activity t -- I (f > f ' r,"t; `<
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlif� v
Beach Bulldozing y ,
Other "�( uL i- i-
/ 7X301
i
Shoreline Length l
SAV: not sure yes no
Sandba s" t e es no
�N
(Scale:
d
)10,/a )
y►�nS
0
D
� i
g . no sur Y k.
Moratorium: n/a yes .no' �-
t i
Photos: yes no `, 4 •-'
Waiver Attached: yes no --
A building permit may be required by: ❑ See note/on back regarding River Basin rules.
Notes/ Special Conditions �+.i i : \ _ I
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit 1
Application Fee(s) Check #
he time period requirement for this
development is suspended until 12-31-
=+yam 2010, pursuant to Senate Bill 831. The
PermltOfficer's Signature
effective date of expiration for this
permit is ,�_I—)
Issui g Date Expiration Date _
Local PlanningJunsdiction 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 (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER!ITOORIIVG PILLNGSIBOATLIF'T,'BOATIIOUSJE) I hereby certify that I own property adjacent to �o!�c12� (/� Gh
(Name of Property O ner)
property located at :9-1 / 6%1
(Lot, Bfock, Road, etc.)
on in
(Waterbody) (Town and/or C unty)
Applicant's phone :!'Tailing Address:3S/y 7V/,Ar0T,tYrW
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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.) GJ 6✓ t
1 do not wish to waive
IN (A)1 do wish to waive that setback requirement
------------------------------------------------------------------------- ------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
3ss1 o Pki4,j r/a--t-w
Mailing Address Signat re
G� A� ,�c-'5-57
City/Stale/Z,ip
6a r)--y-7-yiqd5
phone N,.n b --- - - — —
Signatiirc V Date
P; i:,. yr Type ;vane
1-eiephone Number
Date

1

51
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIVOORING PILINGSI'BOATLIFTIBOATHO L SE)
I hereby certify that I own property adjacent to C2 /�.0 GhU(,/�/
(Name of Property Wrier)
property located at CP-/ / CU,
(Lot, Block, Road, etc.)
on �7�% k�-g in /i�'D r� �If� IN.
(Waterbody) (Town and/or C unty)
Applicant's phone # a OS Mailing Address:w R�N-%�-Ti /2lL
AC
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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me. (If you wish to -*naive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
3s1 a P� T�-� ?�
Mailing Address
--------------------------------------------------------
(Riparian Property Owner Information)
Signature
akYZE�t46A-j) AJ "Ra
City/State/Zip Print or Type Name
phone Nu b Telephone Number
Signature V Date Date

1
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Robert}l Upehureh colonel (ret'L) 66-30i 37 3598
Plr. 252 247-9905
3510 Plan tatiou Rd
jkrelread City, JVC 28557
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First Citizens
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