49713_GARDNER, JACK_20070710

❑CAMA / ❑ DREDGE & FILL � 497 1_3� ?,
GENERAL PERMIT Previous permit#
❑New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resour s
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA C
❑ Rules attached.
Applicant Name Project Location: County A"ram t,
Address E t „'i'eE' \ _ Street Address/ State Road/ Lot #(s) , �� j ��^•���� 1 tiro ,N
City , r"/� State 1_(J _ ZIP
Phone #
F Fax # Subdivision
Authorized Agent City ZIP
Affected ❑ CW ❑ EW ©"PTA ❑ ES ❑ PTS Phone # O River Basin ,
AEC(s): EloEA ❑ HHF El IH ❑ UBA ❑ N/A Adj. Wtr. Body ' v (nat /man /unkn)
❑ PWS: ❑ FC: `
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s) ! ,
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp f
I ,.
Boathouse/ Boatlift
Beach Bulldozing
V
Other
IL
t
Shoreline Length
_ .-
SAV: not sure yea? no
Sandbags: not sure yes
Moratorium: n/a yes nd
Photos: yes
Waiver Attached: yes no
-- _. -- -- — -
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name. r
Signature Please read compliance statement on back of permit
ApplicationFee(s) - Check#
(Scale: N )
t
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
jo 1.<
Local Planning Jurisdiction 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
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888-4RCOAST
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

20o7
i_.
° Sender: Please print your name, address, and ZIP+ in this box •
:-�l ✓.t fig d , ��C" 2. 5 �7
I I I I I I I I II 111111111I I I I! f 11!I I I I II111111111111 IliI I I I I I II 11 11 1
,,,;w* ■ Complete items 1, 2, and 3. Also complete
wr „•.r^'r item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
G'UJ� 1 /4f .
A. Signatur
X ❑ Agent
❑ Addre
B. F rc3cr giv�C_1 d� (Printed LNam �� Dat
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3 Service Type
>�ified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(rransferfrom servi, 7006 3450 0000 8418 3373
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

r'rl (Domestic Mail Only; No Insurance Coverage Protti vided)
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delivery information visit our website, at www.usps.comc,
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0 F F I C I L U-S
CO 7-
Certifled Fee
E3
Postmark
C3 Return Receipt Fee
C3 (Endorsement Required)
Here
C3 Restricted Delivery Fee
El (Endorsement Required)
$
Lrl
_,I- Total Postage & Fees
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or FO Box No.
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I
PS Form 3800, August 2006 See Reverse for Instructions

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I
- -- -= -_ ORING PILINGSBOATLIFTBOATHOUSE)
1 hereby certify that I own property adjacent to ^�G,L /�• �YA�•D+t/f�- 's
t_.ame of Property Owner)
(Lot, Block, Road,-47
41
--- �r�� �.��.i�/ 7 in Z.r'g ���, a N.C.
('ti` atea bode) (Town and/or Count<) ^Sr
f r .-"mooring pilingsiboatlift/boathouse
must be set back a minimum distance of fifteen feet (15) from my area of rip
waived by me.
I do not wish to waive the setback requirement.
APR 2 5 zoo?
I do wish to waive that setback requirement:.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual Pr posing development)
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Signature U
Print or Type Name
Telephone Number
Date: 6 - 7 - Q (o
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JACK A. GARDNER, JR. 66-7489/2531 1624
DAPHNE C. GARDNER 1090000399146
546 DEER CREEK DR.
SWANSBORO, NC 28584 DATE
Y TO
G riniir•n .ter
` — — DOLLARS �e�'
M,. Marino