39323_BORBEAU, TOMMY W_20041109

�✓
L `CAMA / ❑ DREDGE & FILL �/►>�
GENERAL PERMIT Previous ious 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__ c"ro'I >>>' J U;+<i LJ Project Location: County
Address_
L i
City
�r>" %' �7 State
/V <, ZIP :
Phone # (^)T
Fax #
O
Authorized Agent
e f Si{c,
Affected �:] Cw
❑ EW ❑ PTA ❑
ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑
UBA ❑ N/A
;=i Pws:
❑ FC:
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
i
156
SAY 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
Street Address/ State Road/ Lot #(s)
Subdivision
City— ZIP ,1
Phone # () River Basin
Adj. Wtr. Body _ gnat {man , unkn)
Closest Maj. Wtr. Body�V
(Scale: 4 )
See note on back regarding River Basin rules.
Permit Officer's Signature 02 - 61 i'
Signature ** Please read compliance statement on back of permit **
Issuing Date
ApplicationFee(s) Check# Local PlanningJurisdiction
Expiration Date
L ' l, 1 J
Rover File Name

i; �1'41�
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
Neuse River Basin Buffer Rules
Other:
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 (252-946-648 [)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 / 1-888-4RCOAST
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.nccoastaimanagement.net
Revised 10/05/01

WESTERN
THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATSR MARK - HOLD AT AN AN'- To
MONEY iNTEGPATED (PAYMENT SYSTEMS INC. - ISSUES
UNION
I I ORDER- Greenwood village, Colorado
08-072415297
AGENT W6269 DATE 110904 0 +� az-aaio21
TIME 1447 02 '; 00
080724152978 LOCATION! 000047-L0'-``-a%--'4 U*#
k PAY EXACTLY ONE HUNDRED DOLLARS AND NO CENTS�K�K#
PAY EXACTLY
PAY TO THE
I PAYMENT FORIACCT. f
RDER OF
CHA*1ft':iS *11 v
PURCHASER, SIGNER FOR DRAWER
PURCHASER BY SIGNING YOU AGREE TO THE TERMS ON THE REVERSE SIDE.
Western Union Money Order and Design is a service mark of Western Union Holdings, Inc./Payable at argo Bank Grand Junction - Downtown, N.A., Grand Junction, Colorado
is LO 2 L00400i: L,0080 7 24 15 29 ?W8

/�----------rrr.;mrr.vr.
property located at !( Ll Ocz k rv)
(Lot, Block, Road, etc.)
orl
its I �c �(f^t
I5.1cci2 c� _ _ - t ..C.
(Waterbody) (Totirn and/or i(.:aunty) —
He has described to •me, as shown below, the dev--!opi,wnt he is pro —su{ � at ti:at
location, and, I have no objections to his pro-t3osaI. I urtder5mndl a pier/uncovcrecl. boat hf.-
must be set back a rninimum distance or rittern cat (15') rrorn rmy; -a or riparian acc��s unless
waived by me.
I do not wish to waivc the setback rerauirernenc.
I do wish to waive that setback reQuirement.
_ --- ----- -----------------------------------
DESCRI TIOiN N—N-D/OR DRAWING OF PROPOSI:.1.) DFVELOP""LE."-;T:
(ro be fU'ed in b; iizdivi�lucaE„.,� cs: rs ,?e:, »;rent)
€�•aposed 8 � [�' f
House (�jygigrgY
i
------------------------------------------
�)s --
Print or "I-yp•-- N.1tne
Telephone
Date:

May 04 04 07:44p LISR BOURBERU 252 728-5500 p.2
Gf " N T)T>! ,r> I t' 0 WN It:lt
(FOR A PTFPJLUNCO VFR�'D BOA T .I; I r.7)
I hereby certify that I own property adjacecut to---C.MKY1.- � '�� s
of Propertti• O,,ner)
property [gated at V K ocK--� Dc
(Lot, Block, Road, etc.)
on
(Waterbody)___,Q_—_- —, N.C.
(Toirn androrit-:nuntty)
He ha-s described to me, as shown below, the deve!Qp;tt:nt he is propmi.n:; at thatlocation, arid, I have no objections to his proposal. I understand +,hit a pier/uncovcrnr.' boat J.ii:
rnust be set back a minimum distance of rift= r"mot (I3') from my; ar-a of riparian; access unless
waived by me.
I do not wish to waive the se back reauiremer►t.
I Eiji wish to waive that setback requ4rement.
------------------------------ ----• --------------------------•-
DESCRIPTIO A-N-D/OR DRAVVE G OF PROPO.SE1.ri ►iFVELOPIIF -;T:
(71'o be fulled in bY
------------- ----------------
Signature
Print or Tye. N.1mc
Telephone Numb.:.; -
Date:

May 04 04 07:42p LISR BOURBEFIU
252 728-5500 p.1
Fax Cover Sheet
Tommy W. Bourbeau
Lisa L. Bourbeau
270 Oak Hammock Dr.
Harkers Island, NC 28531
[phone]
tbout-beat6ii)ec. ri-. c.om
liSabourbeau(ci ec.t•r.com
To k'661-'L C�
From
Pages (including cover)
Comments Pleo Sc CC-L l t
Cl�leS '9 ha rl i�'5 �
W ha rc. Cw