40935_DAVIS, WENDY_20050329

is A6 _
L'JCAMA / DREDGE & FILL V N'
GENERAL PERMIT lviouspermit #
F]New CModification C!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
QRules attached.
Applicant Name , Project Location: County
Address �' ' ;� ' ' ° r Street Address/ State Road/ Lot #(s)
City L' c„� it, i , / R State C, ZIP
Phone # ( S j -7 t 1 S �Jf l Fax # ( ) Subdivision
Authorized Agent City f"''' �y ZIP
CW C EW E� PTA ES i PTS Phone # ( -) River Basin
Affected 00EA ElHHF ❑ IH � l UBA _ i N/A (`
AEC(s): Adj. Wtr. Body_ f rr — nat man /unkn)
i=7 PWS: �a��❑FC:
ORW- vec / nei PNA (vPc)/ nn rrit_ Minh- vec / nn Closest Maj. Wtr. Body
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
1
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit,*
Application Fee(s) Check#
(Scale: )
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date
Local Planning Jurisdiction
Expiration Date
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 i 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 / 1-888-4RCOAST
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: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

Mar 29 ;05 09:40a
p.2
ADJACENT I:'[1'AIZOAN PROPERTY ON,,Ij FIZ STATEMENT
(FORA ,i'If RJV00,ZING PILINGS/TOf1TkIrTlj;OATHOUSE)
,
I hereby 'ertify that I Q%vn property adjacent la
Game of Property' Qi�'ner)
properly located at (,_�.�-,,.�
(Lot, Block, Road, etc.)
oa �al Q•��. �.-..____ ,N.C.
(Watcrl,otl}') (ToNva andlor Count))
l�Ic leas dc;ctibecl to nie, as shown below, the development lie is proposin; stt that location,
anal, l l. I understand that a picrImoorinoo piUtI_Q3'boatliftlboalhousc
ha1'c ran objections to his proposa
must bc: Set bacl: a nliuial uil distance of fifteen feet (15') From ray area of riparian access unless
Y: $ivcd 11y me.
1 do not wish to «'lire the setback requirement.
T cio wi;h to waive that setback rcgUircntcnt-
---------------------------------------------------------------------------
1ESCF�II'TIO ANWOR DltN\ 'INI G OF PROPOSED DEVELOPMENT:
(To be filfell iu by individua 1proposing dcvelopnicnt) X S je `O e 1 1 L
sfn ► +h � ��- 1Q
'3.(ry CQ
Naj
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--------------------- -----------------
Stgniturc
Print or Type IN'ame
Telephone Number
Date: 1 ic2`7 nD --

Mar 29 ,05 09:40a
FEB-16-2005 WED 02:59 PM NC DIV OF COASTAL MONT FAX NO. 4
p.3
P. 02
A.1)JA(,'ENT 3tI11AIUAT i PROMRTY 0Nj'\F Z STATEMENT
(Poll A f'I ,"..1O0121jYG I'ILI,YGS/l;Ori7Lll"7IROATHOUSE)
I hereby c;,�rtify that I own property adjacent to
(game f PrOncTt' Oivner)
r r.rt ated at loc
(Lot, Blocs;, Roacl, ctc)
,N.C.
(�Vsttcrl>utic) (ToNyn stai Cocll unty)
bic has deseribed to me, as shOWn below, tiic development lie is proposing at thsit location,
ant!, l have no objcclions to his proposal. X understand that a pieriniooringpil'ui;s`boatliCtlboalhouse
niu5t Ue set hack a minimum distance o£ find, feet (15') from nay area of riparian access unless
v.'aiv;:;l by ltte.
I rlo not wish to waive the setback requlrenient.
T do -vish to % aiva that setback requircmcnt.
------------- --------------------------------------------- --
I)F-SCFUP'f[O'\ ANWOR Ditk '1'1NG OF PROPOSEV DEVELOPMENT:
(To be filler! in 0Y 1111-1iridrtrrl prOposin; kvelopmcirt)
X S du\0 4 w k -e rock o �'�
C�� o W oai
Print or Typc
�~ n - Col
7eiephorie Number
Date:

Wendy F. Davis
Ph, 252-745-7131
250 Hunters Point Drive
OL:.,
2252
66-30/531
471
�c�tcr
�j Vandemere, N 28587 l
c-Pay to the h , $
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0 HRSI CITIZEN u4
BaybCio, W Bank 8 Trust Company
Bayboro, N C. 28475
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