34768_ANDREWS, DONALD_20030903

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[-7CAIVIA 7 DREDGE & FILL
GENERAL PERMIT
Previous #
-:Partial
permit
FINew I -I Modification L-lComplete Reissue 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
Applicant Name I
Address 2-1t,
City_( State J1 ZIP 7-4 -511
Phone # 7q Fax #
Authorized Agent • rr 1A
Affected El CW DEW Z PTA ❑ ES El PTS
AEC(s): El OEA El HHF 0 1H El UBA El N/A
El PWS: 0 FC:
ORW: yes / no PNA yes /* Crit. Hab. yes / no
Project Location: County 4 , r 4
Street Address/ State Road/ Lot #(s)
Subdivision 4- .1
City fl 0 ZIP
Phone# (—) River Basin
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Agent or Applicant Printed Name
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Signature Pleise read compliance statement on back of permit"
A C C', KI L
Application Fee(s) Check #
Permit Officer's Signature
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Issuing Date Expiration Date
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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 [)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 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

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YEAR, MONTH, DAY POST OFFICE U.S. DOLLARS AND CENTS
06102705115oo� 285570 ,+ ,�
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ADJACENT RIPARIAN PROPERTY OWNER s,rATEMENT
(FOR A PIER/UNCOVERED BOAT I.I ')
1
I hereby certify that I owes property adjacent to .-.__Iqn4e ,___'s
(Marne of Property Owner)
property located at
(Lot, Block, )`toss etc.)
(W `rb,ody) ( �..dl County)
He has described to ate, as shown below, the development he is propo'eng at that location.
and I isave no objections to this proposal, I understand that a pier/uncovered boast lift must be rtt
back at a m4nimum of fifteen (151) froin my area of ripe Tian access unless waived by me.
�I f do 112 wish to waive the setbick requirement.
I tip wish to waive that setback requirement.
DESCRIPTION AND/OR I)I ANVIING OF P'RO POSFD'DEVELOPMENT:
(To be fiiicd in by individual proposing development)
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Signature`
Te ephone Number
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Print or T pe Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIlER[UNCOVERED BOAT LIFT)
r
t hereby certify that I own property Adjacent to L�-e
J (Name of Property Owner)
property located at -_ (loot, Block, Roo etc.)
Cam'?-..
an
Lfi
' ' in NC
(WV rbody) ( ewn atsdtor County)
He has describird to me, as shown below, the development he is proposing at that location.
and I have no objections to his propotal. I understand thAt a pier/uncovered boat lift must be act
back at a minimum of fifteen (15') f'roin my as -ex of riparian access unless waived by me.
I do IgI Wish to waive the setback requirement.
142 wish to waive beat setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED'DEVELOP �MENT:
(To be fil;cd in by individual proposing development)
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Te!sphone Number
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Print or

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