47116_MELBY, DONALD_20061218

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous p mit#
❑New []Modification ❑Complete Reissue ❑Partial Reissue Date prevous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources -j /
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
E-1 Rules attached.
Applicant Name Project Location: County ( f
Address j'�L �X Street Address/ State Road/ Lot #(s)
City F i •:', T State ZIP
Phone # O i.. Fax # ( ) Subdivision -
Authorized Agent
❑ CW
Affected
AEC(s):
❑ OEA
❑ PWS:
ORW:
yes / no
❑ EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
PNA yes n Crit. Hab. yes / no
City r ZIP i
Phone # ( ) River Basin
Adj. Wtr. Body (nat man unkn
Closest Maj. Wtr. Body —
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale:
/ )
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore —
Basin, channel
cubic yards
Boat ramp
1
Boathouse/ Boatlift
Beach Bulldozing
Other �i. r t
I
Shoreline Length U
SAM not sure yes
Sandbags: not sure yes o
Moratorium: n/a yes no
Photos: yes
Waiver Attached: yes ! --
A building permit may be required by:
Notes/ Special Conditions
(_ .
,
'�•'
I
f ,'
! 11
-
1
I
-
��
-
-
C See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Signature Please read compliance
Application Fee(s)
Permit Officer's Signature,
on back of permit Issuing Date Efkpiratioli Date
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 J 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 (910-796-7215) for more information on how to comply with these buffer 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
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
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888-4RCOAST
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
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

1,
:Af,ER: COMPLETE THIS SECTION
t N Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
U� -�5 —1�c
A. Signature
f
y� _ / Agent �
" f/ d 13 Addressee
S. Receiv y ( Printed Name) C. Date of Delivery j
Is delivery address different from item 1? ❑ Yes
If YES, enter delivery q thew No
3. Service Type ,
$Certified Mail 0 Express Mail
Registered ❑ R�etum Rece(kt for Merchandise ;
❑ Insured Mail ❑ C.}�
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(rransfer from service label) 7004 2 510 0002 2675 7352
ti PS Form 3811, February 2004 Domestic Return Receipt 102595.02•M-1w

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender, Please print your name, address, and ZIP+4 in this box •
31AIA 4Z)
SX2r•P AJ4

ADJA9CENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to DaIKA L,r2S 1 %'46y 's
(Name of Property Owner or Applicant)
Mailing address if different from location address/ d. 13aX
(town, state and zip) ,SAL /e? 11047iyr till_
phone numbers you can be reached at PQ5Q y? 3 ifs ,
property located at Z'qQ Zf- /V ,
(Lot, Block, Road, etc.)
on 190 (. Ct.0 .S'aun 7 �'�►r/�'�'L , 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. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me.
initials
initials
lAl"L��
i
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be f lled in by individual proposing development)
sorr/�4
s a0 / J R)I RNI,6�
M L�^S 1L C/7ANN.CL �
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Signature
Print or Type Name
- L-I 7 -- 3 /- Z. b
Telephone Number
Date: 12 — 7 C
www.nccoastalmanagement.net/Permits/ADJACENTRTPARIANPROPERTYOWNERSTATE,MENT.odf 3

DONALD MELBY
RENEE MELBY
PH 252-247-3826
PO BOX 177
SALTER PATH, NC 28575
Pay to the
Order of_
wmr%..a 1/,7/% Co
LOCAL GOVERNMENT 62
FEDERAL CREDIT UNION MOREHEAD CITY, NC 28557
1:253 LIB 45371:0 L 100777 L 2
2190
66-8453/2531
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