52149_PAIN, VANN_20071218

❑CAMA / ❑ DREDGE & FILL /Reissue
M� w9
GENERAL PERMIT Previouspermit#
❑New ❑Modification ❑Complete Reissue ❑Parti 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
D Rules attached.
Applicant Name
'I
Address l f,)
State ZIP
Phone # (j} );—'i!� " (- C kax # (�)
Authorized Agent
Affected ❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWs:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
1
Subdivision
l '
CityZIP
Phone # (' } River Basin
Adj. Wtr. Body Lat /man lunkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length
i
Platform(s)
Finger pier(s)
Groin length
number
i,
Bulkhead/ Riprap length
1
/
i
avg distance offshore
max distance offshore
I ! `
Basin, channel
I
cubic yards
Boat ramp
Boathouse/ Boatlift s i
Beach Bulldozing I 1
Other
1�
E
Shoreline Len h _ gt
SAV: not sure yes no
I
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes n-q
Waiver Attached: yes no
A building permit may be required by: / ' �' ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
—t
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature f
Issuing bate Expiration Date
Local Planningf urisdiction 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 how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
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

12/17/2OQ7 11:16
I ,
2527261190
P'
NCSPA
PAGE 01
ADJACENT RIPARIAN PROPERTY OWNER STATEM,EN O
(FOR A P.XR1M0oR1,A`CY PrLIN.GS✓B04TCIFT/�aarhiolSFr
e -
I hereby certify that f own properr,y adjacent to 'rid
PuPc ty located at
(Lot, Bloch, Road, etc,)
(Name of Prop" Oweer)
on kR.tv,-
r
(WaterYj +�� `' n
(Tnwn and/or Cooney)
Ele has described to me, as shows, below, the development he is proposin at that) ;7ca,ticn,
and, ! have no objections .o hi; proposal, i understand theta pie
waived by mer/mooring pili"Wboatlift/boathouse
must be set back a minimum distance of frfrcen feet (I S,) from m� area of riparian access unless
.
I do not wish to t4Iaii-e tite setback requirement,
ko wish to waive that .Sctback requirement,
....................... ------ -- ----------- ----------- ...
DESCRIPTION AND/OR DRA WING OF PROPOSED DEVKL0 PMEIsT: -.- .
(To hefilled in by individual proposing develupmewt)
q�5
---I -----------
-_..--------------------------
-._-
+Applicant Information) J(�Rijgn P -
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ADJACENT RIPARIAN PROPERTY OWNER STATEME
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE) '
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at -St-iip t-k3
(Lot, Block, Road, etc.)
on Oat ' N ,, r J4v9,2. , in CAA--Cctt-CT , 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/boatlift/boathouse
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.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
kv 7 r�-C, w -�o1a oo * LL FT
(-(P4 q3
(Applicant Information)
Afailing Address
C-e7C C.
City State Zip
`j L t , -) ).l 2•
Telephone :\'umber
Date
(Riparian Proper Owner 1 or atio
Signan�re
Print or Ttpe .\ame
Telephone Number
ll�o�
Date

F2
Rg(CF TI YV
DEC 1 7 Z007
Morehead City DCM
!PT I)EM
-II VI.: U; -1; FM 7'-4' j
Chades S. Jones, Dfrsctor William G, Ross Jr. Secret it
La
.......... . . ---
Appli cant Name P ��J
Up, H' Address
pr
I certify that I have authorized (agent)
�WV
to aci: On mill
behalf, for the purpose of applying for and obtaining all CAT IA Permi s necessary to
install or emistruct (ar-ti3Oq-)
at (location)
4
This cerufi
Si,anabure 7 r -

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