41757_BRANTLY, BILL_20050525

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GENERAL PERMIT ''�
Previous permit #
�:7New F 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
pp ' ' € -''�� Project Location: County Rules attached.
Applicant Name Y .
Address r � L- Street Address/ State Road/ Lot #(s)
City c ���/ /" I -State 'J ZIP
Phone # (1i1) '1 l L i Fax # ( ) Subdivision
Authorized Agent i ! �( ; �' ' t City _ __ _ _ ZIP_
Affected a CW Q-PTA ❑ ES ❑ PTS Phone # ( _ ) - - River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH UBA ❑ N/A Adj. Wtr. Body_
E PWS: ❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body - - - —
_ gnat /man /unkn)
Type of Project/ Activity
(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 V—
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 #
T/ /)
See note on back regarding River Basin rules.
Permit Officer's Signature " y"
_ r� � L✓l 1/C � �y f / �
Issuing Date Expiration Date
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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
_I 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 / 1-888-4RCOAST
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.nccoastalmanagement.net
Revised 10/05/01

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CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of individual applying for permit: Cicr- ( Q e
Address of property: \t4 -0
(lot or street #, street or road)
(City & County)
I hereby certify that I own property adjacent to the above referenced property. The
individual applying for this permit has described to me (as shown on the attached
drawing) the development they are proposing. A description or drawing, with
dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Ave., Morehead City, NC 28557 or call [phone]
within IO days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or sandbags
must be set back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature Date
Print Name
Telephone Number With Area Code

Postal
CERTIFIED
MAILT.RECEIPT
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Total Postage & Fees $
05/05/21105
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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
! 1. Article Addressed to:
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A. Signature r
X ❑ Agent
❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Ice Type y
Certified Mail ® Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
oransferfrom service &1W 7004 2890 0003 4770 4054
±`PS Form 3811, February 2004
Domestic Retum Receipt - - - - - - 102585-02 M 1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •

■ Complete items 1, 2, and 3. Also complete A. si nat
item 4 if Restricted Delivery is desired. X
+ ■ Print your name and address on the reverse
so that we can return the card to you. R ived by
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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❑ Agent
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tT Registered ❑ Return Receipt for Merchandise
13 Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
2. Article Number
(rransfer from seMce labeq 7004 2890 0003 4770 4061
PS Form 3811, February 2004 Domestic Return Receipt
- — -- --- -- - 102595-02-W1540 ------------------ --

UNITED STATES POSTAL SERVICE First -Class Ma9
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
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Pay to the
Order of_
CARL HEVERLY
7306 CANAL DR., PH. 252-354-7154
EMERALD ISLE, NC 28594
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