40713_DOUGLAS, GORDON_20050103

`iCAMA { ) DREDGE & FILL
GENERAL PERMIT Previous permit#
❑New ]Modification E,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
O Rules attached.
Applicant Name �{jr%:�iRJ `i-; - .� Project Location: County_ r- 1
Address_ r •� �E- �,��,e!'� .��. � ��•7 Street Address/ State Road/ Lot #(s)
City c 'fit i{F State ZIP
Phone # Fax # O Subdivision
Agent
Authorized ` �� City i`l 1AMf/CPCCh ZIP__'�z; {'l
h �: �.
Affected 1 CW OfW E� PTA ❑ ES ❑ PTS Phone # (_ ) River Basin
OEA HHF 1H I -I USA ❑ N/A
AEC(s): ❑ El Adj. Wtr. Body_ :`v•Uf `�• (nat /man unkn)
PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platforms)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore _
Basin, channel
t
cubic yards_ __
Boat ramp
Boathouse/ oatlif x I i I i
Beach Bulldozing
Other
�tf
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
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 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, certify that this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules i 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 (9 (0-395-3900) 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

�WESTERNI (MONEY
UNION ORDER
INTEGRATED PAYMENT SYSTEMS INC. - ISSUER
Greenwood Village, Colorado
08-072415637
AGENT 306269 DATE 1?2E04 ,
TIME- 1033 02
o o
080724156371 LOCATION 000047-LL.`
## PAY EXACTLY ONE RINDRE.D DOLLARS APdD NO CENTS
PAY EXACT 17
Y - 1
PAY TO THE 1� �D
ORDERIjOF PA`/'9Ei I fOf'tR(, T.
&"l,cllfiASER'S ADDRESS%/1 ^(���
`_ l ' —0ASEN. SIGNER FOR DRAWER
PURCHASER By SIGNING YOU AGREE TO THE TERMS ON THE REVERSE SIDE
Western Union Money Order and Design Is a service mark of Western Union Holdings. Inc./Payable at Wells Fargo Bank Grand Junclinn - Downlown. NA., Grand Junction. Colorado
I: 10 2 1004001: 40080 ? 24 1 56 3 7 Lill

_ G o Pao,, o G c4c�s
.�f',.L7,�11��� I ; �dl.i."1lr Y .Ti:i� 14.F1 \"� l.P� �Y I�F,t
(FOR A PIERIUNCOVR.ED ,BOAT LJFT
I hereby verify that I own propemy adjacent to C9og�1�( �u 6 eflS ';
('`+acme of Property Owner-)
proper'y located at —
(Lot, Block, Road, etc.)
onin i�1'`��G `l�cf-� CA-(Z1 N.C.
(Waterbody) (Town and/or! Co nty)
He has to me, as shown below, the developrnent he is proposing at [l at
location, and, I have no objections to his propesai. I understand Ghat a pier/uncovered boat fir:
must be set back a minimum distance or n *Lee:i f(f--,L (I5') from myiarca or npanan access unless
waived by me.
I do rot wish to waive the scEback requirement. CIP
Fza
I d wish to waive that setback recu'remenC. 'EC 2 8 2004
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Si�'ature
rint or Type Name
Telephone Numb( r
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Dec=23-04 10:38am From -Dixon Huzhes PLLC [phone] � s T-117+9 P.002/002 F-246
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ftiAme iDf Property V vfntr)
Properly Io=tad zt
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(fir a[erbady) crown =di orj Go Lv)
e .has des:zjbfi En me, as sno¢;, below. he teve:optpent he is ,prOPas'kny a�
I=dan, wd. I have no obje--dons cc his propcUl- I undestand O ,v a gi► X/uaCC;verzd buac lift
rtu5t be set bars a minimum discw= of ff-=n fe:�-, (15') from MY 4r" Of riparian a+Ess nT]Iess
wa.ivec! me; -
I da Z2 WiAl 'in waive xfback x 11ir-- tent -
I ,j4 wish W waive thze setback requirement. ;
CEO DESCR1o?� �lOR Y�w�rG OF
(To be flute in ay fncfiy4AZ1 proposing de�el�pncerft)
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