51556_POLLMAN, MARK_20080104

-6 166
❑ CANIA / ❑ DREDGE & FILL z t o
GENERAL PERMIT � Previous permit #
❑New ❑Modification ❑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
D Rules attached.
Applicant Name_
Address
City
Phone # ()_
Authorized Agent_
Affected ❑ Cw
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ZIP J`
Fax # ( )
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body ' (nat /man /unkn}
Closest Maj. Wtr. Body 4
Type of Project/ Activity
(Scale: )
Pier (dock) length -
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore-TT--
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
'
t
`
I
-T7
I
Shoreline Length _
I ; I I I I
SAV: not sure yes no —
I
Sandbags: not sure yes no
Moratorium: n/a yes noET
Photos: yes no
Waiver Attached: yes no
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name o -�
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local Planningjurisdiction 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
❑ Neuse River Basin Buffer Rules
❑ Other:
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
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ I-888-4RCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

JAMES E. DAVIS NCDL 5446287
DBA DAVIS MARINE CONSTRUCTION
PO BOX 1264
SWANSBORO, NC 28584
Pa to the
Order of-_61� , / r
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2760
1 / - 0 66-30/531
Date 341
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to FIRST CITIZENS BANK
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GUAROIAN®SAFETY YELLOW WOYE

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT FOR CAMA
MINOR PERMITS
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I hereby certify that I -ems -property adjacent tow.I c H c L ,A; F CC' c pAl e L. - k e r 's
(Name of Property Owner)
property located at .5' L- r P G i4 1 )-tic ko Y ) c,. c 1= Cc Y
(Address, Lot, Block, Road, etc.)
on Al S' C P_ F ez k , in e ._� C c .-_ A T- i , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing devel f
Mai
ahead City ®CM
Signature F T P s s t.
MAC►. 14,1Cr, C r��1Pr=Cihl4u�,I;
Print or Type Name
Telephone Number
Date: I 1 / 7 / '2 c, 0 1

is for illustrative purposes only -
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SCALE: 1" = 30
03-04-97
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT FOR CAMA
MINOR PERMITS
Du�R
I hereby certify that I own property adjacent to I eHoL S ��1, E' /,'s
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on Ut2�t�S Cr222K , in %I.ow a uh � , N.C.
(Waterbody) (Town and/or County
ne has described to me as shown below, the development he is proposing at that location, and, I have no
objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Print or Type Name _
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Telephone Number
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pursuant to NM 47-
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THIS MAP IS NOT A CERTIFIED SURVEY AND NO
PLACED IN ITS ACCURACY.
' MAY BE I
RELIANCE
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CAROLINA Yho� (9to) _24 -
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SCALE: 1" = 30'
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DISK.aCAD 2811 DWG:BOATDOCK.DWG