47101_BAILEY, BOYD_20061208

❑ CAMA / [--]DREDGE & FILL
GENERAL PERMIT
ENew ❑Modification ❑Complete Reissue ❑Partial Reissue
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
Applicant Name
Address ; 70
City
State ZIP
Phone # ()
Fax # ()
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit. Hab. yes / no
Previous permit #
Date previous permit issued
O Rules
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Mal. Wtr. Body
Type of Project/ Activity
(Scale: )
Pier (dock) length
Platform(s) M I
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel
�
{
j
i
cubic yards
Boat ramp
Boathouse/ Boatlift F
j
1
i
I
-
{
-
I
I
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
I
I
--- -
on back regarding River
- - ---
rules.
l
— - - --
❑
See
note
Basin
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Officer's Signature
Issuing Date
Expiration
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
1 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
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/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mali
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

11/18/2006 08:45 2522433539 PAGE 01
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( 11fr Afffliw1w. to waive the I S' Setback requiujnXenii,
1 fill .1pitce to waive Ilia 1 V srlbfrck i
(M'ru:ti 4
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OF COASTAL
P. 02
PROPERTY OWNER STATEMENT
NT
(FORA A 1'IIsRlA'1'l ORIN!"i PILINGS1130ATI11,17BOAMOUSE)
I IK-f:l,y CQIA1 thi,t 1 uwia properly a d.faceait to 0
_ 0. _•
(Name uT Property OvVeer) D
le
Addrms, Lot,11tcick, Xtiis;cl, etc.) ,'' �-•
Oil
(«l:t1��� i7ilc �) (Towax sand/or Count C9
I Ic; stiv leas-do,;cribod to anc, as•shown below, tlac development he/she is proposing at Ct
foc:ttitui' rind I havo tro objcctic►!is to this Pmpusaf- I understand tint a pier/nloorijIg
lei l i rzt;s!lu�.tt f ift/G�,s;jt hctiuse m usi be set l�2ciG a to ininiutu d istance of f fteen feet (15') {'rom my tlt e.� of
minis, Waived bywo. I have indicated my intentions by initialing below:
-
1119 —6-61gi-W to waive the 15' setback requirt:nxc:nL
. ..
+1-P lArcc to waivC I11C, 15' s0back require4ijetit.
- w
Il<ERCRI IFYON AND)OR 1t1i.AW3NG 019P OPOS1:T11nFVj�,[,OPMLN,I,:r
('Tu be. filled fn by iru4vidurrl pfoposin,, development)
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Print or Type Name
Telephone Number
Date:

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Drew J. Lutheran
122 Fawn Prive
Emerald ble, NC 285g4
Ph. (g10)382-7024
?Qy to EhQ. � _..��
RBC CENTURA BANK
101 W 8 MCCLEAN DRIVE
CAPE CARTERET, NC 28584
8 comn;ns sec,ny
onazu�res. oeu;�
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