34590_CHAMBLEE, JOHN_20030808

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' C1 CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Previous pe it #
!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
G Rules attached.
Applicant Name
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Address %t
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City__:_'
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Phone # ) JU
-2 - J Y�/ Fax # ( )
Authorized Agent _
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Affected ❑ CW
LZ'EW
D-PTA ❑ ES
O PTS
AEC(s): ElOEA
❑ HHF
ElIH ElUBA
ElN/A
❑ PWS:
❑FC:
ORW: yes / no
PNA
yes / Q Crit. Hab. yes / no
Project Location: County
A
Street Address/ State Road/ Lot #(s) (-) l j �C O ,, C +
Subdivision
i
City— �'":�' -,eS ZIP—��� -2
Phone # ( )
River Basin
Adj. Wtr. Body(nat Jman /unkn)
Closest Maj. Wtr. Body --
Type of Project/ Activity
(Scale: ' \I )
Pier (dock) length
Platform(s)
Finger pier
Groin len
gth
er
Riprap length
distance offshore
yards
/ Boatlift
dozing,
not sure yes
m: n/a yes no
i
yes i
stance offshore
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Agent or Applicant; Printed Name
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Signature "Please read compliance statement on back of permit
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Application Fee(s) Check #
--W-rmitOfficer'sSigr#t !!
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
f/
Agent or Applicant; Printed Name
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Signature "Please read compliance statement on back of permit
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Application Fee(s) Check #
--W-rmitOfficer'sSigr#t !!
Issuing Date Expiration Date
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, 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
Neuse River Basin Buffer Rules
❑ Other:
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

ERIC B.ELLIS NCDL - 65047
JASA A4. ELLIS PH [phone]
205 NOTTINGHAM DR.
MOREHEAD CITY, NC 28557
2504
PaY W the Date
Orderof - I—
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BANK Bank /33
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133

©1/13/1995 18:14 9199636070 NC INN BROKERS PAGE 01
ADJACENT RIPARIAN PROPERTY OWNER STATE��'
(FOR A PIERIUNCOVERED BOAT L)FT)
7 hereby certify 'that I own property adjacent to .,It '; Frjysry S
(Name of Property Owner)
PrIDPeM located at /Q—,", A o r-
(Lot, 81oc1k, Road, etc.)
on A""* /
to
(Waterbody) , N. C.(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 a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I o of wish to waive the setback requirement.
& wish to waive that setback requirement,
-------------------------------- _____
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPME,,s7:
(To be filled in by individual proposing developmens)
I
-------------------------------------------
------------------------------------
na re
Print or Type Name
Telephone Number
Date: 9 k - 6

ADJACENT RIPARIAN PROPERTY OWNER STATFAIENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify 'that I own property adjacent to 's
%� r� (Name of Property Owner)
property located at 11— (/--,'�
(Lot, Bfock, Road, etc.)
on .�.dl/ , in z , 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/uncovered boat lift
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.
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
%f-/"37-
-----------------------------------------------
Signatur
Print or Type Name
a2w
Telephone Number
Date: U