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CAMA / Cl DRED9E '- &FILL �, TM 48174
Q- --
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 15A NCAC
❑ Rules attached.
Applicant Name . `;-. �, : ` L .• i Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( ) Fax # () Subdivision
Authorized Agent City ZIP
Affected El CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # (_ ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ 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
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
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 by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit,
Application Fee(s) Check #
(Scale:
r
L:
— See note on back regarding River Basin rules.
Permit Officer's Signature
yl
Issuing Date Expiration Date
Local Planningf urisdiction Rover File Name
)I
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 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:919-733-1495
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888ARCOAST
Fax: 252-247-3330
(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: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent toJ64. )'+ E6g4(Ao-A gt&k' 's
(Name of Property Owner)
property located at C-�i, \aLkAP1 �J �-D . I2u)
(Lot, Block, Road, etc.)
on� � V—IVOit , in N � , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and,1
have no objections to his proposal. 1 understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15') from my area of Marian access unless
waived by me. (If you wish to waive the setback, you must initial the a C
below.) . �w 122"wip1 )
1 do not wish to waive V, J U N 0 .5 2007
I do wish to waive that setback requirement.
------------------------------------------ ------ ---------------- ---CM
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
----------___-�- ac .--------_LAQ-f---------- -
Signature
Print or Type Name
// ++ telephone Number
Date: `T
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILIIVGSIBOATLIFTBOATAOUSE)
( t
I hereby certify that I own property adjacent to
(Name of Pro er r)
property located at 0-f 6 N Q Lk &piN /J _
(Lot, Block, Road, etc.)
Oil %] . + ✓ e (J�F2 , in I.� i2 L� N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, 1
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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.)
I do not wish to waive T : IVED
I do wish to waive that setback requirement.�/
-------------------------------------------------------------------------------------��-�.-Q- 7007
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
----------------- - -----------.--------�- -----
Sivnature
Print or Type Name
252-�33—/ 74e9
Telephone Number
Date: 31 ' Z° o?
NC FLOATING DOCKS & LIFTS LLC BB&T 1645
1822 S. GLENBURNIE RD. STE. 5 BRANCH BANKING AND TRUST COMPANY
P. O. BOX 13907 1-800-BANK BBT BBT.com
NEW BERN, NC 28562 66-112J531 3/19/2007
PH. (252) 672-0555 '
*a200.00
PAY TO THE CAMA
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D-MACHARTER LLC
4912-C BRIDGES STREET EXT
BRANCH BANKING
AND TRUST COMPANY
MOREHEAD CITY NC
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