33148_CAPPS, WILLARD JR_20030117

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f(JCAMA / El DREDGE & FILL
GENERAL PERMIT Previous permit
LNew —]Modification I - , Complete Reissue E—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 15A NCAC
E] Rules attached.
Applicant Name I Project Location: County___
Address Street Address/ State Road/ Lot
City—i­ ---State zip
Phone # Fax # Subdivision
Authorized Agent city-- ZIP -
Affected 0 Cw 7 EW 'EZ PTA El ES El PTS Phone # River Basin
AEC(s): EJ OEA 11 HHF b IH El UBA Ll N/A Adj. Wtr. Body— (nat /man /unkn
El PWS: El FQ
A.--
ORW: yes / no PNA yes d no Crit. Hab. yes no Closest Maj. Wtr. Body --
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
-T­ T
Bulkhead/ Riprap length
avg distance offshore r
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length ........ . .
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no Ll
A building permit may be required by: f Vl
Notes/ Special Conditions
I
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River
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Basin
rules.
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Agent or Applicant Printed Na.rne
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Signature Please read compliance statement on back of permit.**
Application Fee(s) Check #
:
Permit Officer's Signature
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Issuing Rate
Local Planning jurisdiction
Expiration Date
Rover File Name
111&riw VL, .41

,
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 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 (910-395-3900) 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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

UNITEDSTdTES 17oSrr�,j. Y ORDER,
20287 030114 `28557a a�1�00*D0
POST OFFICE `� .Y..M U.S. DOLLARS AND CENTS
ER YEAR MONTH DAY
CHECKWRITER; f` MII I �� I�.D a�� • •� n ^`�
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/IMPRINT AREAPAY TO
F t Ais
ADDRESS 2
A ES
C.O.D. NO. OR •0
USED FOR NEGOTIABLE ON �IN THEa S.-AN� POS SSIONS
SEE REVERSE WARNING
0800 2' 2 3 L 7 10 28 7!�'
1:0 0 0 0 1 • 9 L

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIF
-�-�� ;�
I hereby certify that I own property adjacent
(Name of Property Owner
property located at
(Lot, Block, Road,\4wc.)
1
on �7 in tx- , NC.
( aterbody I (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/uncovered boat lift must be set
back at a minimum of fifteen (15') from my area of riparian access unless waived by me.
o not wish to waive the setback requirement. ��N 3
_ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
Signature
2 6a -1 6 - W-
Te ephone Number
Print or Type Name
Date

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to �s
(Name of Property Ow e
property located at J
(Lot,�-Block, Road, etc.)
on in
NC.
(Nfaterbody f (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/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. JAW 1,3 R[r,"D
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
ez� Az
Signature Print or Type Name
Telephone Number
r, e? / h � z
Date