33198_ZARANSKY, KAREN_20030225

PCAMA / p-bREDGE & FILL
GENERAL PERMIT
Previous- rmit
E]New EModification []Complete Reissue LJPartial Reissue Date previous permit issued
As authoriied 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
El Rules attached.
Applicant Name
Address
City-, �ef e
State ZIP
Phone #
Fax #
Authorized Agent
Affected El CW
EJ EW
E PTA El ES 0 PTS
AEC(s): El OEA
Ll HIHIF
El 1H El USA 0 N/A
El IPWS:
El FC:
OIRW: yes [no
PNA
yes / no Crit. Hab. yes no
Project Location: County_
Street Address/ State Road/ Lot #(s)
Subdivision
City_ ZIP
Phone# River Basin-,,
Adj. Wtr. Body (nat /man /unkn)
Closest Mai. Wtr. Body
rm(s)
-71
11
.r pier(s) c,
length
number
ead/ Nprap length_
avg distance offshore
max distance offshore
,channel
cubic yards
ramp
use/ Boatlift '3
A
Bulldozing
1114
1 <0
r
I I
line Length
not sure yes no
ags: not sure yes no
orium: n/a, ye: n
ye �ri:
r Attached: yes 6n
Agent or Applicant Printed Name
cl�
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Planning jurisdiction

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 ❑ 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-411COAST
Fax: [phone]
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)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
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
910-395-3900
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

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499 CRUMP FARM RD.
NEW BERN, NC 28562
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JJ h�- C 1v 1 tutrflr�N Jr KUrk K I Y U WNER SI A'TENIEN J'
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
s
(Name of Property O er)
property located at ' 7�7i� ^ �
(Lot, Block, Road, etc.) '
on ��� -, �" �1v � , in N.C.
(Waterbody) (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. I understand that a pier/mooring
pilings/boadif-Jboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
--------------- ------- _
DESCREMON ANND/OR DRAWDr G OF PROPOSED DEVELOPNIEN-F:
(To be idled in by individual proposing development)
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Telephone Number
Date:

'"Jhk-r-iV 1 xU-rAItL .iv r.KVYN,K 1 Y V YYIv L x
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 4 �, ,s
(Name of Properly weer)
property located at
(Lot, Block, Road, etc.)
on
` ,N.C.
(Waterbody) (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. I understand that apier/mooring
pilings/'boatlil-rlboathouse must be set back a minimum distance of fifu--n fit (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP�NfE_NT:
(To be filled in by individual proposing devellopment)
' '2 d-"-'� - 1 `
Print or Type Name
Telephone Number
Date: