48458_BLAIN, ANNA_20070413

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New El 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_
i�
n,- /6 -c� 7 and
Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name j-A ` Project Location: County
Address - `' `? }.k>- <.- Street Address/ State Road/ Lot #(s)
City �``' ;m ` State ZIP
Phone # O
'i' .7
Fax # O
Subdivision
Authorized Agent
City ZIP
❑ CW
❑ EW
❑ PTA ❑ ES ❑ PTS
Phone # () River Basin
Affected
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /man /unkn)
❑ PWS:
❑ FC:
Closest Maj. Wtr. Body
ORW: yes / no
PNA
yes / no Crit.Hab. yes / no
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
Moratorium: n/a yes
Photos: yes
r
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:
See note on back regarding River Basin rules.
f � f
Permit Officer's Signature
Issuing Date Expiration Date
byj3b1A.
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/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(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:[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

MAR-29-2007 09:51 From:,NC DIV COASTAL MGMNT 2522473330 To:2526336588 P.1/2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLI,b'TIBOATIIOUSE)
T llcruby certify that I own property adjacent to
(Name.. of Properly Owner or Applicaid)
Mailing address if different from locativil address 90_D o O„e 6,ee A—
(town, state and zip) Bel 1,1
phone numbers you can be reached
property loca(ed at bffo G o-ose _
(Lot, Block, Road, etc.)
on t re I IJ�JI�..... , ir,. (lf ,e ��j = , N.C.
(Waterbody) (Tuwn andfor County)
Ile 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 picrhnooring pilings/boatlift/boathouse
rnu5t be set back a nunitnurn distance of fifteen feet (15) from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement,
iuitials
1 do wish to waive that setback requirement.
initials
--------------------------------------------------------------------------------------------------------•----------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVFLOPMENT:
. . (To be filled in by individual proposing development)
---------------------------
--- - - ---------------------- r
J `
SignaturC
Print or Type None
ZZk
Telephone Numb&
Dace;._- .�

��r� Sig,

MRR-29-2007 09:V Frorr,,:NC DIV COASTAL MGMNT 2522473330 To:2526336588 P.2%2
ADJACL4NI' Itil'AItIAN I'ItOYERTY OWNER STATEMENT
(FOR A PIERIAWORING PILINGS111 IATI,I FTIROATHOUSE)
I hereby certify that I own property adjacent. to
(None of Property Owner or Applir..W)
Mailing, address if different from location address %a© 9&aw- ChQQ. /L
(town, state and zip) Q1 tj 'rrk � 1. @q -1
phone numbers you can be reached at. 2 q' 3 IV?
,
property located at
(Lot, Block, Road, etc_) (�
on —T—�C/Vg R i Vje� ---, in �� Ct r Ct"� N.C.
(Waterbody) Cl own an(Vor County)
He has described to nee, m 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/boatlifAoathouse
rnusi. bC sct hack a rninitnum distance of fifteen feet (1.5) from my area of riparian access unless
waived by me.
T do not wish to waive the setback requirement.
initials
I do wish to waive that setback requirement.
initials
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developrnen[)
-------------------------------------------------------- --- - - - -------- ---------
_ --
Sion\atu]re
Pwil or Type Name
�_
Tcicphane Numbbe�r
Dote: ✓ ` -- f

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RICHARD D BLAIR UAW
ANNA G BLAIR 2721
700 Goose Creek Road
New Bem, NC 28562 ���3-0�7 66-21/530
BRANCH 77620
nilriu� ,VliDE/JP, $ ctolOO
WACHOVIA
Wachovia Bank. N A IS
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