40705_CLARK, CRAIG W_20041214

10
` 705
' CAMA / ❑ DREDGE &FILL �E ,�
GENE_ PAL PERMIT Previous permit # f C
❑New I ]Modification ❑Complete Reissue ]Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
.f
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name
Address
City r*.-- State ' t ZIP i
r <c L r C- C- C+
Phone ( �y4 7Zlo-1 µZ4 Fax # ( )
Authorized Agent
Affected ❑ CW D EW ©PTA ❑ ES ❑ PTS
AEC(s): I OEA C HHF ❑ IH ❑ UBA F-I N/A
❑ PWS: ❑
ORW: yes 6-0 PNA yes /'nn� 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
SAV: 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
Project Location: County ('--I( " �'- : e- _ Ce-.
Street Address/ State Road/ Lot #(s)
ib A-,
Subdivision
// ZIP
City �'� !<"+tt/Y'< < hc°l G �+
Phone # ( ) River Basin�-
Adj. Wtr. Body /� �1t'%1 �flt i'/ / (nat /man /unkn)
Closest Maj. Wtr. Body—,
)) i
(Scale:
A
I
.L
It -
Agent or Applicant Printed Name
Signature * Please read compliance statement on back of permit
Application Fee(s) Check #
See note on back regarding River Basin rules.
Permit Officer's Signature
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, 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 (910-395-3900) 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

WESTERNI INIONEY INTEGRATED PAYMENT SYSTEMS INC. • ISSUER
UNION ORDER- Greenwood village, Colorado
08-072415585
AGENT W6269 DATE 121°�az-aonoz1
TIME 1346 02 �io�
080724155858 LOCATION 000047�%-1j',1j PAY EXACTLY K PAY EXACTLY THREE HUNDRED DOI-LARS AND NO CENTS
PAY TO THE T
ORDER OF PAYMENT FQR/ACCT, #
PURCHASER'S A Pt-q0
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ACF PURCHASER, SIGNERPURCHASER BY SIOMNG YOU AGREE TO THE TERMS ON THE REVERSE SIDE.
r and Desi o Is a service mark of Western Union Holdings, Inc./Payable at Wells F nk band Junction -Downtown, N.A., Grand Junction, Colorado
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ADJACENT RIPARIAN PROPERTY OWNER STATEMERr
o
I hereby certify that I own property adjacent to � �i1
(Name of Property
Owner)
propertyatad at
(I.ot, Bio&, Road, etc.) A
on Cid� D' 13��e�n G'.4 1Pl . 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEI,OPMFNT
(To be JMed in by iwdiv &d proposing dipokpment)
Lot 34
w1IiINK
-bo i ' - -Anico�.
Oft!
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WP 4p- Or
o 04 v
^old WAII .
L4+ 3 8
CInR 1c
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Acoss
Signature
Print or Type Name
7/i ,I //., , 5s 3y
Telephone Number
Dale: % ��/ ")r

ADJACENT RIPARIAN PROPERTY OWNER STATE ME TI'
I hereby certify that I own property adjacent to A� , 1'q'ek's
(Name o[ Owner)
y L&� 3S 8i /�'-A�i�c�d9�'%t ems' S:3�ii�vs AvE
prweltn � (IAA, Block, Road, etc.) A
on � a off( 13oq c.e�(An iG le441el .) N.C.
(Waterbody) (Town and/or County
He has de='bed m mo as shown below, the devch4m ont he is proposing at diet location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOMO 'I'
(To be J ed is by in bi&d p vposixa AkPe opwwt)
L.4- ' 34
sy,� f" 4r-vd
o OIK
mold WA
L4+ 38 1 Lo f 3'7
wi 11iaw CIAA k G,cosr.
:�- -71 ?L4x_'/ V i -z
Signature
Print or Type Name
S'l & - C/e-3 __2 63
Tele0hone Number
Date: