46011_PAPLHAM, MARSHA_20061010

N�-�1-ova 166
C-CAMA / ❑DREDGE & FiLL
GENERAL RJERMIT
Pre us #
permit
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources -
3
and the Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC
L iRules attached.
Applicant Name
Project Location: County G
Address '''' r_ Jv r
Street Address/ State Road/ Lot #(s)
City �,1 " 4� r State ZIP \�
Phone # # Fax ty f / ~ :,.. •
(^) ()
Subdivision af'!lr"G1
Authorized Agent !",a
City t ' '� � /L � ZIP
p-CW ❑fw [9P"A El ES ❑PTS
Affected
Phone # ( ) River Basin
❑ OEA n HHF ElIH ElUBA El N/A
AEC(s):
Adj. Wtr. Body ` ' ' `"" 0)man /unkn)
❑ PWS: ❑FC:
tj e «�
ORW: yes / no PNA yes' / no Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)_
Groin length
number
Bulkhead/ Riprap length 1
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
' J i
SAM not sure yes
Sandbags: not sure yes 1
Moratorium: n/a yes l9
Photos: yes no
Waiver Attached: yes :no
A building permit may be required by:
Notes/ Special Conditions
:3)
Signature **-Please read compliance statement on back'oTpermitw' 6Y
Application Fee(s) Check #
(Scale: jvop-9—'. )
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
j, /4-0 O i'/t]— '-
DCsuing 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, 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 (910-796-7215) 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/ 1-888ARCOAST
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

I hereby certify that I rr;pn prey adjacent tci
jj
(iame of pso�erty �3mner) ____�''s
properly located at LCTT h '�
C3.,0t, 1006k, Road, etc ;)
in
�)
(Wa# od (fawn axidlar Canae-
He has d to me s:r shown below, the deveI,)gment he is proposing at dW lac�,ddn
and, I have no ot�ecdons to his ,croposaL
DMON AMAM ]DRAWING 0] `pi4C►POSED I)EVWp}�
(T he flag 1 in by hz6P&a& prvpo' z, cg deveinpment)
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Pry or - 'ype Naane
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TetePhOly: Number
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I hereby bertify ghat I cnrn grOPerry a4jarent to � �
's
Ilk arrxe of Pr opert3' owner)
property I0cam!d at
Ain
He has desmi-bed to me. -I.: i.,own below, &1e devd::,: ment he is
pr'apasng at that oA
and, I have no objection to hi` :;:ro L &J,
o,4-L riz "TC `' n(e � i ` -�+ U ►� y
DE�UMON r u�ii�ii_)R DRAWING Off`
- pR t_1 pOSEI3 I3E'I'
(!`� �e,e7 a� $� irtdividuaZpropos cg deve�apme�rt) .
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Prinz Or ;'ype Name2�L �eV
Tellgphm' 11 umbe,
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To: Y
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Broad Creek Construction, Inc.
P.O. Box 268
Merritt, NC 28556
Phone: [phone]
Fax: [phone]
Email: infDOBroadCreekConstruction.c_om
www.BroadCreekConstruction.com
From -
Pam p� `C � � Pages; -
Phone: Date; j c) /3 /�&n
0 Urgent ❑ For Review ❑ Please Caenment ❑ please Reply 0 Please Recycle
0 Comnumts:
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* 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.
19 Attach this card to the back of the maifpiece,
or on the front if space permits.
1. Article Addressed to:
2. Article Plumber
(transfer from service label)
PS Form 3811. August 2001
A. Signature
i ❑ Agent
.,f 0 Addressee
B. Received b• ( Printed Name) _Date of. Qaltery
f t L'
D. Is delivery address different from item 1? O Yes
If YES, enter delivery address below: 0 No
3. Service Type
❑ Certified Mail Q Express Mail
0 Registered 0 Return Receipt for Merchandise
❑ Insured Mail ❑ C.U.D.
1 4. Restricted Delivery? (Extra Fee)
?004 0750 0002 3353 2395
Domestic Return Receipt
rn
rL.l....".._.d_.._.N...�..ti.�ax�,.9,:�...,T:r
11 Yes
102595.0140-2509
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paittrit Reajg7` ai
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Ras7wrted Calivary =aa �=
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Total PaiiLg:r�25 tLa7 G �J O ij
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Z'd N0110f1�J1SN00 �133210 CIVO�JO eM 90 t0 100

CERTIFIED MAIL - RETURN RECEIPT REQUESTER
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of individual applying for the permit: c 6
Address of property: ��-� A TNI� . 2� t7 F w'i
}� (Lot or street#, street of 'o/ad`)
(City c Cnunty)
I hereby certify the I own property adjacent to the above referenced property. The
Individual :applying for this permit has described do me (as shown on the attached
drawing) the development they are proposing. A description or drawing, with
dimensions, should be provided whit this letter. (o-) 4N vaC(4 M JTS
I have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Ave., Morehead City, NC 28557 or call [phone]
within 10 days of receipt of the notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or
sandbags must be set back a minimum distance of 15' From my area of riparian
access unless waived by me. (If you wish to waive the setback, you must initial the
appropriate blank below.)
I duo wish to waive the 15' setback requirement
�L
r 1 do not wish to waive the 15" setback requirements
Signature / E y Date
Print Name ��
Telephone number with area code
CA N011om]ISN00 >133210 GVO118 eC£:6 6 90 t10 100

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BROAD CREEK CONSTRUCTION 4660
PH.252-745-4252 66-112/531
11 CREEKVIEW CT BRANCH 01901
MERRITT, NC 28556 9572 �/l ��c n
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BIB&T
BRANCH BANKING AND TRUST COMPANY
1. =-BANK BBT BBT.com
l:053101120:00052927 46C3
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