32832_SULLIVAN, REX_20020823

CAMA / ❑ DREDGE & FILL n,bl� 32832C.._.
GENERAL PERMIT Previous permit # °y
-JNew ❑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
❑ Rules attached,
Applicant Name
Address
City State
Phone # Fax # O
Authorized Agent �-
Affected ❑ Cw ❑ EW I PTA
AEC(s): ❑ OEA ❑ HHF C IH
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no
ZIP
IIES C PTS
_i UBA f_ N/A
Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ___ ZIP --
Phone # ( _) _ _ River Basin
Adj. Wtr. Body (nat /man, unkn
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
i ;�
;
_•
c�,
)
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
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Beach Bulldozing
Other
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1
Shoreline Length77
SAV: not sure yes no
Sandbags: not sure yes no #�1-1
Moratorium: n/a yes no_
.._ .
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
1
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❑ See note on back regarding River Basin rules.
Agent or. Applicant Printed Name
Signature e.VPlease read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date, Expiration Date
/rIA.
Local Planning jurisdiction Rover File Name

ft
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 ❑ 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 / 1-888-4RCOAST
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

UNITEDSTATES
15-NO POSTAL MONEY ORDER
90528738175 0 8
SERIAL NUMBER YEAR MONTH DAY POST
DOLLARS AND CENTS
PAY TO CHECKWRITER
IMPRINT AREA
ADDRESIS I
FRO
ADDR
.C.O.D. NO. OR
USED FOR
ate
1:00000,500 21: NEGOTIABLE ONLY INWHE-U.S . AND POSSESSIONS
90 S 28 7 38 1 ? So

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED*OA �
I hereby certify that I own property adjacent to _ ;'s
(Nam of Property Owner)
property located at
(Lot, Block, Road, etc.)
on �7 -ty�e°✓ in
NC.
(Waterbody) (Town and/or unty)
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/uncovered boat lift must be set
back at a minimum of fifteen (15') from my area of riparian access unless waived by me.
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 e fill dinby individual proposing development)
I
z��Al /`�
� I 'Al
Signat re Print or Type Name
I_ ? 19 10
Telephone Number Date

r
i FROM .7C--LASS FAX Np.=95.5C2@2 Aug. 2C 2002 05: yatrl F1
Aut-21-2 �; :.1 Frcn-BBkrL^ _ — --) �;. ! "8[a �3�y 7-243 P 002/002 F-6r84
7 -
ADJACENT RIPARIAN PROPER' V OWNER STATEM JNT
(FOR A PIERIUNCO'V'ERED(P►O3 T LI
P
I hereby certify that I own property adjacent to
(Run of lroperty Owner)
property located at
(Lot, Block, Road, etc.)
on NC.
(Wsttorbc�dy) (Town a !or County)
Re has described to tile, lag shown below, the development be is proposing at that to .ation,
and I have no objections,to his proposal. I understand that a pierluncvvered boat lift rases be set
back at a minimum of fifteen (15') from my area or riparian Aeeess•un)ess waived by me.
4) ' r I do not wish to waive the setback requirement.' -
I & wish to waive that setback requirement.
,DESCRIPTION AND/OR DRAW INGW FROP0SED VE VEL0FMEN' :.
(!'o be filldgGia by individual proposing development)
Signature
T=1apltQtl@ ;ti�..mber
Print or Type Name j
I
Date }
I�