47068_GOTARD, HANK_20061122

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date pr
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
it #
permit issued
Rules attached.
Applicant Name �"'== =ram) '•K. �� Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # () Fax # () Subdivision
Authorized Agent City ZIP
4 " 0 -1)S:ti_
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF El IH ❑ UBA ❑ N/A Adj. Wtr. Body nat /man /unkn )
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
—I
number
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Bulkhead/ Riprap length
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avg distance offshore
max distance offshore
Basin, channel
cubic yards_I-
Boat ramp
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Boathouse/ Boatlift
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h Bulldozing
Beach g
—
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Other
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Shoreline Length a
_�_
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
F-T-
J
fIJ-
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
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit"
Application Fee(s) Check #
Issuing Date
Local Planning Jurisdiction
Expiration Date
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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules U 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
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
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)
Morehead City District
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-796-72i5
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORINGPILPVGS✓BOATU BOATHOUSE)
I hereby certify that I own property adjacent to NAM K 4' 9V;a Gz174g 's
(Name of Property Owner)
property located at 137 Noer;,; Shbt-e 7>e Gbw,&-14a.&c.,
(Lot, Block, Road, etc.)
on in PMMQVj=0 Cr CCACMECrW SI ) , 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/boadift/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 befilled in by individual proposing development)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PLERIMOORING P1UZVGS/BOATUFTBOAMOUSE)
I hereby certify that I own property adjacent to 14AIIK 4" G gigez 's
(Name of Property Owner)
property located at 137 NoerM Shbge PC 616w&APO 7Qocsc-
(1,ot, Block, Road, etc.)
on 1`1V&rW lei 1 fJ in /Cb Cr CC. =Mgr 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/boaditt/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)
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Print or Type Name
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Telephone Number
Date: // - /2- —v 6

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of individual applying for the permit: AgHK 4— Cd i G &W7- 42�
Address of property: 3 % Neel-;'L S WW-Jr -bat yW—
(Lot or street#, street of road)
"BEAU 4=0 -r-- IN/CA2T l
(City & County)
I hereby certify the I own property adjacent to the above 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 whit this letter.
// I have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Ave., Morehead City, NC 28557 or call [phone]
vk1thin 10 days of receipt of the 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, boathouse, lift or
sandbags must be set back a minimum distance of 1S' From my area of riparian
access unless waived by me. (If you wish to waive the setback, you must initial the
appropriate blank below.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15" setback requirements
it /z
Signature Date
Print Name
z � -V911)-� 7
TelephoneTelephone number with area code
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■ Complete items 1, 2, and 3. Also complete
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:
Mr. San, 5�'a6w
Ga U+ i & k s Ms.
3 1'S'S 3
2. Article Number
(Transfer from service label)
A. Signature
❑ Agent
X r� ddressee
B. Received by (Printed Name) C. Da a 2 geliverti
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. ervice Type
ertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
PS Form 3811, February 2004 Domestic Return Receipt
& —40t7— 6 674
102595-02-M-1540