33952_BELL, MICHAEL B_20030424

CAMA / i- DREDGE & FILL
GENERAL PERMIT
ENew _IModification CComplete Reissue `-Partial Reissue
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
Applicant Name
Address �' W !/ `
City ti' - : I � State ZIP = {` r7 3
Phone # (_) CL-?f. Fax # { )
Authorized Agent
Affected -i CW ❑ EW I] PTA ❑ ES O PTS
AEC(s): ' OEA ElHHF ❑ IH ElUSA El NIA
PWs: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
'BUJ
Previous it #
Date previous permit issued
1 `7-
Rules attached.
Project Location: County Cam• -ItI +
Street Address/ State Road/ Lot #(s)
► �'v fey R� /l pf
Subdivision
City_
I If, ., V
ZIP
Phone # () River Basin
Adj. Wtr. Body 1, (nat /man /unkn)
Closest Maj. Wtr. Body fe f? '
Type of Project/ Activity
► AI* Mr
f
�
, is r'IAi
.
(Scale:
,✓<N�
)
Pier ( r i/ ►
Platfo
-
. ���
q �t►�/'i�I�iiiiHLiir����I1�n���N% ��� � �� IMP
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit **
?�
Application Fee(s) Check #
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit **
?�
Application Fee(s) Check #
Permit Officer's Signature
il 7 's
� , y. o;
Issuing Date
Expiration Date
Local PlanningJurisdiction
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 ❑ 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 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 / 1-888ARCOAST
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

L NCOL 2262666
M1CH E H BELL NCDL 2527365
.'726-2625"' ,,_726-5839
%l(70Wp
5028557
c
MOREVIAD GIVs
,
VIOC110,1115, I.C.- - Cl
3 --- - --.
li
3689
66-1521531

ADJACENT RIPARL- -N PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOC'SE")
I hereby cer-dfy that I own property adiacent to
(Name of Property Owner)
prope.y located at U ''� z E 0 /
(Lot. Blo , Road, etc.)
I
on % % , in N.C.
(Waterbody) (Town and/or County)
He has described to me, as s<<own below, &,e deve?opmen: he is proposi-=-- F-t t`at location,
and, I have no obiections to his proposal. I unde=.—d teat a pie:-Imoo *
piiings;boatlifrfboathouse must be setoack a minimum distance of f f-Leel feet (lf') from my are-
of r1uLian access unless waived by me.
I do nnt wish to wai,,-e the setback: requirement.
I S n_ wish to waive tat setback- recuire,11ent.
DE.1'SCR1PTION AND/OR DRAWENG OF PROPOSED DEVELOP`IE T:
(To be filled ir by individual proposing development)
ahzlrl�aj-
4 , 4". -
J3X y .v�►k
-------- —------- ---------- —--- ----------------------------------------- ---- -
A, -4
Signature
�s
Pant or Type Name
S-2
Telephone Number
�2-
Date: 2

ADJACENT RIPARL�N PROPERTY OWNER STATEI�LE1N
(FOR A PIER/MOORING PILINGSIBOATUFTIBOATHOUSE)
I hereby cer-dfy that I own property adjacent to &'Oae � ! �� l -s
(Name of Property Owner)
property located at / 3c2
(LoC lock, Road, etc.)
or, i,t.5� K , in0 -/ -__
, N.C.
(Waterbody) (Town and/or County)
He has described tome, ass -own below, the developmen: he is propos:-_ a_ that location,
and, I have no objections to his proposal. I unde:s:=:d tha7 a pied moor-'ng
pEns:s; -c-oatlifJboathcuse must be szr back a minimum distance of T lfteen f= (5') from my area
of rparian access unless waived by me.
I dn nnt wish to waiv-- the setback require rye: t.
I dn. wish to waive �.at setback rcuirement.
DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEVELOP%IENT:
(To be filled ir: by irzdividafZ propose; devm elopent)
54-
piI b I
go L) I
C) DOe7
�zD
�1 e,grr,K
SIR azure
Print or Type Name
Te.Ieohone Number
Date: �-C� Z d