48123_BLAIR, ANNA_20070307

.3-16dl 164
❑ CAMA / ❑ DREDGE & FILL
r. GENERAL PERMIT Previous permit #
iE]New ❑Modification El Complete Reissue ❑Part&& 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 /r\ , ;1C:L , Project Location: County
Address i .; c. (` t ii at Street Address/ State Road/ Lot #(s)
City I �-(1) &
Phone # ( '-)_
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State '' ZIP
Fax # ( )
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ USA ❑ N/A
❑ FC:
PNA yes / no Crit.Hab. yes / no
Type of Project/ Activity
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: )
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 r; _
Sandbags: not sure yes 6no 7
Moratorium: n/a yes 1/no,
Photos: yes r
Waiver Attached: yes Gryb -- - -- — - - - �- - .---
A building permit may be required by: © See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name `
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local PlanningJurisdiction
Rover File Name

lb
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 howto complywith 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

BAN-24-2005 MON 01:31 PM NC DIV OF COASTAL MGMNT FAX NO. 4 N.
ADJACENT RIPAPIA9 PROPERTY owNER sTxrE. mEt r
(POR A PII;R/MOOIUNC PILINGS/ROATLIIT/BOATHOUSE)
I hereby certify that I own property adjacent to R rc A Ay-C (`f J n r-1 - /3 td i-s
(Name of Property Owner)
Prolxrty located at 7 o C- C1 c) ; - e
(Lot, Block, Road, etc.)
on--T-�� _ rZ, ; -e (, , in �){ ;✓ (� E 6 c- N.G.
(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/boadi11/boathouse must be set back a minimum distance of fifteen feet (15') from my area
Of ripari;ui access unless waived by, me.
1 dt!_nnt wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/Olt DRAWING Or PROPOSED DE'VELOPME :
(To be filled in by individual proposing development)
--------------- ------------------------------------- —---------------- -----------------------------------�
Signature
Print or Type Name
Telephone Number
Date:

A41-24-2005 MON 01:31 PM NC DIV OF COASTAL MGMNT FAX NO. 4 N. U?
,,.DJAC ENT RIPAIRTAN PROPERTY OWNER STX17EMENr
(FOR A PIER/MOORING PILI'NCS/ROArLIFTIBOATHOUSEI
I hereby certify that I own property adjacent to _l ?r LJ rc �i�� l/J4 �"'s
J (Name of Property Owner)
property locatM at /l (% d E' c/' r c e_
�� r� (1'ot, Block, Road, etc.)
Oil I � -1 V� 1L (` , V � v— , ail py/.� w� �� b'1 , N.C.
(Waterhody) (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. 1 understand that a pier/mooring
pilings/boadifi/boathouse must be set back a minimum distance of fiftm-n feet (15') from my area
of riparian access unless waive by me.
i do_nat wish to waive the setback requirement.
t da wish to waive that setback requirement.
DFSCRIPTION AND/OR DRAWING Or PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-- — - — --------------------------- — ------- — -------------------- — ---- -- --- -------------------
Signa re
/WJ'KS-
Prinir Type Name
Telephone Number
Date:

2712
RICHARD D BLAIR
ANNA G BLAIR
700 Goose Creek Road
New Bem, NC 28562
Pay to the
i order of
WACHOVIA L 1;3V
Wahovia Bank, N.A. .
wachovia.
For
COS 30002L91:L0360431OB8411' 27L2
Q
W21/530
Date
Dollars