39329_CHESNUT, STAN_20041207

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CAMA / -! DREDGE & FILL
GENERAL PERMIT Previous 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 U
(� Rules attached.
Applicant Name a••
Address
zcx
City T , "' r 4,-'N1 ,._ State Vt ZIP
Phone # ( ) "
00 - Z 7 qq Fax # ( )
Authorized Agent
7 - MO ^ - t
Affected ❑ CW
0 EW [I PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
❑FQ
ORW: yes / no
PNA yes / no Crit. Hab. yes / no
Project Location: County , a It.. t
Street Address/ State Road/ Lot #(s)
Subdivision
city 1,4 IOki f C 640rI ZIP 724 r1
Phone # () River Basin 1.)k�-
Adj. Wtr. Body rrlor Mylir '.7s o { (nat /man /unkn)
Closest Maj. Wtr. Body Ro< "r 1G V t^ Q
Type of Project/ Activity
(Scale: NCi —, )
Pier (dock) length
Platform(s
)- --I.'
ber
Riprap length
istance offshore
nnel
'
dozing_
Length
not sure yes no
/
n/a yes th
_ _
:
r
, 1 _ ►1 _
I
1
- I �
I i i i i
I ,
yes no
I �
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
i'-terra►��L✓Lvy�i-
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File Name
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
i'-terra►��L✓Lvy�i-
Permit Officer's Signature
Issuing Date Expiration Date
Application Fee(s) Check # 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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
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: 9 l 0-350-2004
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

► '
THIS MULTI -TONE AREA OF THE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY
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ISSUING BRANCH
5-7091
DATE
PAY TO THE
ORDER OF
EISSUED By: �
TRAVELERS EXPRESS COMPANY, INC. L� � / , /
& MINNEAPOLIS MN 554B0
DOLLARS
.DRA :BB&T
AUTHORIZED ATIjRE�
P.O. BOX 947 , _ -----
DRAWEE: BOSTON SAFE DEPOSIT & TRUST CO BOSTON MASSACHUSETTS
MEMO/PURCHASER
tin? 7 2 59 244115 1:0 1 lo0 709 1:O L600 104 5 109 2111,
GNATURE LINE AND BORDER. ABSENCE OF THESE FEATURES WILL 11
■ THIS DOCUMENT HAS AN ARTIFICIAL WATERMARK PRINTED ON THE PACK. THE FRONT OF THE DOCUMENT HAS A MICRO -PRINT 51

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�7.D J A CEI `I�� J� j_ S:" : iIi :CAI I � i � 1! r Z � O9'WNJI��F,t S ',t. ,l � y pp, 3,, T
f l.: ;t. ;. ..i A ._Ul .l.
(FOR A PIER/UNC-- OVER.ED BOAT L;II7)
I hereby certify that I own properry adjacent to
(','`':ILiD(I or Property O wiser)
property,• located ateAK -77y-;; A
(Lot, Block, Road, etc.)
orl
5Vaterbodv) (Town and/or �ountj)
He has desc.nbed to me, as shown belox, the developr;nent he is proposing at tt;,
location, and, I have no obje--tions to his propos;,i. I understand 11hat a pier/uncovered 'boat 1i
must be set back a minimum distance of n tepn r"c--t (15 from my area or d arian access uriles
waived by me.
Ld
I do riot wish to waive the setback require elf.
JUL 0 9 2004
I do wish to waive that setback requirement.
Morehead City DCM
DESCRIPITONi ;`N-Dt0R DRAwTvG OF PRO POSED; DEVELOP-IYMN-':
(TO be j7dled in bti' individucl proposing deveLppmerzt)
c� D
Signature I
Print or Type Name
Telephone Numbtrr
Date:- p -- -

e �
J� ® Up
'P� k-
m Clpt &ININ l
1
Morehead City DCNi
0
0

Ia A.P.
(FOR A PIERA"'V"'GVT 7
-
I Ilereb c--tufy that I cwt) profrert -tit to
ir
p roper%y
A, etc.)
u -fL A (Tow-D 211mil—d'orlCotiotf)
He
hisdesc.-ibcd to rot, ,s shown bellOW. thr- t he 15 i7roi at 0-al
r0jx)U v a pr-f/uncov-:rct� beat Ilf-
jc<z6on, and, I have no objd::�iOils W Ilts p ulide�5LIpil
must be set back a minimum distance u( (15') irOrn "Y riparian 0(
waived by me.
aQj wish to wawathe setback
to waive dii1t ,aback rcquirerncw.
. . ........ ...D.... ---------------------------------
UCAUP140IN A_N-L)IOR DRAIlrUNCY OF pRopo-q-11)
be Riled in bit
JULS�� R�7Tfl�tk�-D �,�5
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0 9 '2004
Morehead City DCM
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