52397_SNOW, FRANK_20080812

9 El C AMA / 0 DREDGE & FILL 5 9 7
GENERAL PERMIT Previous permit#. rZX C—
LINew DModification ElComplete Reissue ZPartial ReissDate 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
0 Rules attached -
Applicant Name 4 Project Location: County
Address
City
Phone # (—)_
Authorized Agent
Affected El CW
AEC(s): [I OEA
[I PWS:
ORW: yes / no
State ZIP
Fax # (—) --
P EW i PTA Ll ES 0 PTS
L HHF 0 1H 0 U BA 0 N/A
� IFC:
PNA yes / no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s) LwLivk
Subdivision
City ZIP,
Phone # River Basin !J(!L'4
Adj. Wtr. Body t?,�4� Knat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check#
Permit Officer's Signature
Issuing Date Expiration Date
-7
-1110
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, certifythatthis 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/ 1-888ARCOAST
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

Aug 04 08 07:07p Audrey ARNOLD
252-726-3018 P•3
A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F, Easley, Governor .fames H. Gregson, Director William G. Ross Jr.. Secretary
Date � --_�� n tV
AppHeautName
,M.-Ijng A ces&s7 7
I certify that I have autborizea (agent) to act on nrty
behalf, for the purpose of applying four and obtaining all LAMA Permits lnecessWy to
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install or construct (activity)
at (location) -. / 6 0
This certification i"alid (date) �� D
Signature
4o0 Commerce Avenue, Morehead Cty, North Carolina 2B557
Phone: m-808-2808\ FAX: [phone] lmemet: wwv.nccaastaimanagement net
Ar. Equal 0=&jr n l Atliim6Yo Action Ertwlge - SU6 PeryCaa 1 t 0'�6 °at Cansumw'spor
l'd eqo:Lo g0 g0 6ny

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/1fOORl1VG PiLI,VGS'BOA TLIFTIBOA THO r.1SE)
hereby certify that I own property adjacent tom/�z
's
(Name of Property Owner)
Property located at
(Lot, Block, Road, etc.)
on
,in ,N.C.
(��'ate o@) 4 (Torn and/or�ouy
He has described to me, as shown below, the developnient he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/rttoorino pilings boats; R boatnoc1se
most be set back a minimum distance of fifteen feet (i S') from my area of riparian access unless
waived by nie.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
- -----------------•-.-------------
---------------------- ___
ESCRIPTION AND/OR DRANS'I.NG OF PROPOSED DEVELOPMENT:
(To be filled M by iltdividiial proposing deti,plopillc>1rt)
O
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------------I---
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A------------------------ I -------
SignatureDrJ
Print or Typ
e Name
Telephone Ntinzber
Date: °-3

ADJACENT RIPAR.IAN PROPERTY O«VNER STATEMENT
(FOR A P'ER/1100R11VG P1L1,'VGS,'BOAT•LI TIBOATHOT.ISE)
I hereby certify that I own property adjacent to
's
Property located at
(Name of Property O,.ner)
(Lot, Block, Road, etc.)
on
in %✓.�� �� —� , N.C.
(Waterb dy) (To�� and/or Cauntti)
He has described to me, as shown below, tlle cievelap dent he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/n,00ringpiiings-boatliRboatrto�tse
must be set back a minimum distance of fifteen feet (I j') from my area of riparian access unless
waived by nee.
140 not wish to waive the setback requirement.
I do wish to waive that setback requirement.
--------------------------------
ESCR.IPTION AND/OR DRAWING OF PROPOSED DEVELOWsIENT:
(To be frlied iii bi• i"ifividunl proposing de "elopment)
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