45730_VALENTINE, GERALD_20060612 (2)

El CAMA / ❑ DREDGE & FILL
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
�e
_ v-IffTRules attached.
'
Applicant Name ti �:-
Project Location: County
; ✓ �r'
Address d C..% :_Jf AU r',.'�0,
Street Address/ State Road/ Lot #(s)
City A � State ZIP
Phone # ( ) ' J ~! ` t! -' Fax # O
Subdivision
Authorized Agent
City
ZIP ✓ ' }
Affected LiCW ❑ EW ElPTA ElES ❑ PTS
Phone # O
River Basin
El N/A
AEC s : OEA ❑ HHF ElIH ElUBA El N/A
Wtr. Body
1 Y
t � ' '� ` r4ai-/man /unkn)
❑ PWS: ❑FC:
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no Crit. Hab.
yes / no
Type of Project/ Activity 1-5
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin,' channel A
cubic yards
Boat ramp
Boathouse/ Boatliff 1
Beach Bulldozing
Other
Shoreline Length
SAM 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 by:
Notes/ Special Conditions
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name j j Al 1 2006 Permi cer's Signature
.� V 1'i %
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Signature^ Please read compliance statement on back of permitead Ci}" 18Expiration Date
ApplicationFee(s) Check# 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 I 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 Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
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/ 1-888ARCOAST
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

P
ADJACENT RIPARIAN PROPERTY OWNER A
(l%QR ii PIF,RAtitQaRING PILINGS/AQATI,IFT/BO E1 - <1006
I hereby certify that I own property adjacent to
(Naune of property Owner)
property located at 5` 3 $ W e (:I —
(Lot, Block, Road, etc.)
on �R,S � r e e V— , in M e- N\ZA� �`� N.C.
(Walerbody) (Town and/or Coanty
fie has d; scribed 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
pilin;s/boatlift/bfiathousc must be set track a minimum distance of fifteen feet (15') from my area
Of riparian accem unless waivtxl by me.
w - , l sl wish to waive the setback requirement.
1 sj.Q wish to waive that setback requirement.
lW-SCRIPTION AND/OR DRAWING OF PROPOSED DEVE-J,0PM1r,,NT:
(To be filled in by indf► mal proposing development)
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Telephone Number
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,,4t Wit Neach, SUB 28512-7322 AA
252 247-1890 DATE _.['
PAY TO THE -
ORDER OF
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u , Look - for. Micro Pon[ signature line, gray tvpe and linework. First Citizens Bank logo on back. If not present, do not cash.
HRST
EWust Company 33
BANK Atlantic Boach, N.C. 28512 � �n
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