51855_DILLINGER, BUDDY_20071221

❑CAMA / ❑ DREDGE & FILL
i
GENERAL PERMIT Previous permit
❑New ❑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
❑ Rules attached.
Applicant Name Project Location: County
Address
City State ZIP
Phone # ( ) Fax # ( )
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
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s) I
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required
Notes/ Special Conditions
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by:
❑ See note
on
back regarding
River
Basin
rules.
Agent or Applicant Printed Name
Permit Officer's Signature
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
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, 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/ 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

1.
Appendix A
Adjacent Riparian Property Owners Statement
(for a bulkhead, dock/mooring pilings)
I hereby certify that I own property adjacent to *=rZA C. s
(Name of property owner)
property located at Lo i Z / Z C�Ssoi, Z
(Lot, Block, Road, etc.)
on A- E4 in C' (Z,4 v E rL) , NC
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 dock/mooring
pilings 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.
1 do wish to waive that setback requirement.
Description and drawing of proposed development:
(To be filled in by individual proposing development)
i
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Signature
Print name Date
K F(n COcJR:j N j;�w R F.,z __ 5 '�L— 6 3 S- b 9 C�Lf-
Address N 2g� 6 0 Telephone number
A-2 � C10 Q V
NOV 2 6 2007

Division of Coastal Management
Adjacent Riparian Property Owner Notification/Waiver Form
Name of individual applying for permit: _r_ /�, ' , ,y) , L, c.: `�'(
Address of Property: ;' <;,-} s ,f,y U
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Manage-
ment, 400 Commerce Ave, Morehead City, NC 28557, or call [phone] within 10 days
of receipt of this notice. No response is considered the same as no objection if you have been
notified by certified mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, lift or sandbags must be set
back a minimum distance of 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.
x, I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature
Print name
5 6-3 �3— c/"374--
Telephone Number with Area Code
A-3
Date
1— _'�b
Address or Lot # in Fairfield Harbour

J11 P
J
Appendix A
Adjacent Riparian Property Owners Statement
(for a bulkhead, dock/mooring pilings)
I hereby certify that I own property adjacent to "--,Z:-(?-lA 2, �ji«i,J�C� 's
(Name of property owner)
property located at Lo i 2 � 6e) / Z C "q-s s-0 C' 4y-,Y Z /✓
(Lot, Block, Road, etc.)
on k E/J cr Css� cRrw?G in C �yE r� , NC
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 dock/mooring
pilings 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 drawing of proposed development:
(To be filled in by individual proposing development)
I
signature
Print name
g /? / //� �/�- z -/A
A ridrPcc
A-2
12
Date
2s2 z i
Telephone number

Appendix A
Certified Mail -Return Receipt Requested
Division of Coastal Management
Adjacent Riparian Property Owner Notification/Waiver Form
Name of individual applying for permit: -s C"
Address of Property: Z o i Z 5/ Zd, 2-
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal Manage-
ment, 400 Commerce Ave, Morehead City, NC 28557, or call [phone] within 10 days
of receipt of this notice. No response is considered the same as no objection if you have been
notified by certified mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, lift or sandbags must be set
back a minimum distance of 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.
- L/- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signatur
Print name
Date
Telephone Number with Area Code Address or Lot # in Fairf
A-3

IRA C. OR MARJORIE J. DILLINGER
PH. 919-847-2056
2405 HAMRICK DR.
RALEIGH, NC 27615
Pay to the Iy
order of
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6058
Date � Z� c+
22-7615/2960
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