41137_COPELAND, WESLEY_20050321

-i I_
AMA / DREDGE & FILL
GENERAL PERMIT
'w
Previous permit #
ONew 1 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 I SA NCAC
�f` ' )e q Gf
—I Rules attached.
Applicant Name t``: ! + I
Project Location: County ___
Address - `� r1 � f �
Street Address/ State Road/ Lot #(s)
City f ,i �. -d ILkI-k' State 'f-"6 ZIP
_
Phone # ( ) -2 - t, ( i Fax # ( )
Subdivision R
Authorized Agent , �' ' -`
City - ZIP __
CW ❑ EW NJ PTA El ES ❑ PTS
Affected
Phone # ( ) + °� River Basin
❑ OEA [❑ HHP ❑ IH ❑ UBEl N/A
AEC(s):
Adj. Wtr. Body J! (nat /man /unkn)
ORW: yes / no PNA yes / no Crit. Hab.
Body Wtr.
yes / no Closest Mal. — -
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
SAM 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
ens orc.pli ant i e ame
l�
� �!
Signature Please read compliance state ent on back of permit
(Scale: )
r, _ , r*
See note on back regarding River Basin rules.
Permits Officer's Signature
Issuing Date Expiration Date
Application Fee(s) Check #
Local Planningf urisdiction
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:
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 / I-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

MAR 0 s 2005
lo e 0 al Ewa] I W a ak4 a 101 Zi�� W
an to
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONINN'AIVER FORM
Name of Individual a 1 s for Permit:
PP Yin ., _ p
Address of Property:
(Lot or Street ft, Street or Rod, 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 pro sing. A description or drawing, with dimensions, should be provided with this
lette
r.0
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Afanagement, Hestron Plaza H, 151-B, My. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the sarrie as no objection
if you have been notified by Certified Afail.
WAIVER SECT10
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift o-, sandbags must be
set back a minimum distance of 15' from my area of riparian access unless waned by me. (If you
wish to %valve the setback, you must initial the appropriate blank below.)
i do %vish to waive the 15' setback requirement.
4-J. I do not wish to waive the 15' setback requirement.
Print Name
Telephone Number With Area Code