34085_BUTLER, TAMMY_20030609

-ICAMA / ❑ DREDGE & FILL l
GENERAL PERMIT Previous 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
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant Name ' tI M M'-/ 1; t� 7-1 ,:k-
Address ij 2- Cif 5 f A 1, P
City_ '. State ZIP -, 7-VI S
Phone # ( j`) i F - �5y�� Fax # O
Authorized Agent GG R -.
Affected 0 CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): -1 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: JFC:
ORW: �es / no PNA yes / no Crit. Hab. yes / no
Project Location: County %o : 4 f , r -*
Street Address/ State Road/ Lot #(s)
Subdivision
City ' +Y T ZIP ""&
Phone # ( ) River Basin'
Adj. Wtr. Body /man /unkn)
Closest Maj. Wtr. Body JF'Cf 4' f �CL' I'"!;
ow
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit'*'*
Application Fee(s) Check #
Permit Officer's Signature
C3
Issuing Date Expiration Date
1 f, 4- ?"©609 ►8R r n
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 / 1-888-411COAST
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

JERRY GOWER CONSTRUCTION CO, INC.
PH 365-9767
7324 SIEMENS RD
WENDELL, NC 27591
pay to the
Order of_
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to oel 's
9_ (Name of P operty Owner)
property located at 61
(Lot, Block, Road, etc.)
on 13,040-- o0e yit,N� , in d -6/ , 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.
I do not wish to waive the setback requirement.
,9UN 0 6 2003
I do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
To
AM.
Date Time P.M.
While You Were Out
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Phone
Area Code
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MESSAGE IWZMY 13u.TLI-ERL
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SIGNED
Reorder No. 01325
URGENT!
TELEPHONED
CAME TO SEE YOU
RETURNED YOUR CALL
WANTS TO SEE YOU
PLEASE CALL
RUSH
WILL CALL AGAIN
Sig ire
TL�(r �,y �1OVye,r
Print or Type Name
Telephone Number
Date: 6 ` ✓�'"�

f,Aw M 7 Sun

ADJACENT RIFARFR0PERTY O'R?NRR STATEME-N"T
(FOR A PIRRfMOOR G PIZ.msIBOATL1FTIRDATHOUSE)
I htreby certify that I own pros arty adjacent to 7 ,aac s' � 's
I (Name of Pro rty Owner)
property heated at
on
aterbody)
(Lot, Biock, Road, etc.)
in
} fyown andlor 'County)
HeiYas dt ,tibed �co me, zs sh below, the d�eiopr�t he t%propq�ing at t� 1Q"I�ion,
and, I have rm ob�tions to I' ,•s proposal. I a�rdersmrw rhar a #eTlmc�ng
pilingSJaoatYiYtll�pan.�m►�se irrn9t be � bk d mir<<;;�um ��stanc� of ftif4e�,� feel. ��5') fcgrn m� area
of riparian locess unless waived iy
5 �
t duo nQf wish ro waive a settrack requircrmnTe.
I Siff wish to waive that zback requirement. JUN 2003
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DLSCRTFrI0Nt AN"DIOR JNI G AiV07F PRON)SEDUE�iF.itAPiYFE�T:
(To be filled.in inrrvzdUat proposi"hg developrnenrj
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