32920_CLEMENTS, LINDA C_20021120

,T CAMA / C7 DREDGE & FILL
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 15A NCAC
`iI Rules attached.
Applicant Name L ,,,kiy ? . jr 1"'.4 S _
Address `17 A fg � I t ,-?
City__ l!'�ur..�nr I _ State N( ZIP
Phone # (') : i ' Fax # ( )
Authorized Agent J' t ('
Affected ❑ CW 7 EW 21 PTA ❑ ES ❑ PTS
AEC(s): ElOEA HHF ElIH ❑ USA [I NIA
❑ PWS: ❑FC:
ORW: yes / no PNA yes / Co
1 Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin Lak
Adj. Wtr. Body r-4 v p. ryl c'lr r u c i- ` (nat /ma-h: /unkn)
Closest Maj. Wtr. Body— V -• 1
Type of Project/ Activity czr t • E u tf it a
' 1 it f'. J Ova . l(Scale: /t%LNr )
Pier (dock) length
Platform(s)
Finger piers) ! I �—
Groin length
number
Bulkhead/ Riprap length
I
(
j
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1
I
avg distance offshore
max distance offshore
Basin, channel -- -- ..._----
cubic yards
Boat ramp — — —
Boathouse/ Boatlift V VVi 0 ' 4
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—
_
4
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I
Yitft
—
t
--
—
_
--
JI
13'I
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--
Beach Bulldozing
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Other---- ------ --- — —
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_
Shoreline Length
SAV: not sure yes fio ': ��'
Sandbags: not sure yes no
Moratorium: n/a yes
Photos: yes no
Waiver Attached: yes no
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A building permit may be required by:
�fpr'
See note
on back regarding River Basin rules.
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Notes/}Special Conditions Alt
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Agent or Applicant Printed ame
Signature "Please read compliance statement on back of permit"
e'r-
Application Fee(s) Check #
� 1 /
Permit Officer's Signature
J7f(I- I.[Ci
Issuing Date Expiration Date
,11J1",, t plan `T V ( 5 - C A
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 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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules [_I 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 / 1-888-4RCOAST
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

THIS MULTI -TONE AREA OF THE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY FROM UAHK IL) uum V"I1 v. 1-..�..� ��••• •-- ^
NOT VALID OVER $1,000.00 - Q,917 8 6
ISSUINGBRANCH r._
93-541/920
DATE rtl`'ti1Fr1F•F6' `�I"1 "•lil'i^
PAY TO THE 43 $1 Ut} .O0 *3
ORDER OF , 7
4 DOLLARS BY SIGNING YOU AGREE TO THE SERVICE CHARGE
.1 AND OTHER TERMS ON THE REVERSE SIDE.
DRARA
DRAWER: TRAVELERS EXPRESS COMPANY. INC
P.0 BOX 9476, MINNEAPOLIS, MN 55490 AWEE: FIRST INTERSTATE BANK. HFLFNA. CAT
C A' - 1 R 6 `�"1 j1 _ - -- Vt�4 CZIW I N (�+ �..-_._._----- ---- - CITY B STATE
li'6L69�7bEit' 1:0920054111:0L707L045L09211,
■ THIS DOCUMENT HAS AN ARTIFICIAL WATERMARK PRINTED ON THE BACK, Il IR FRONT OF Jill: LACUMLNT HAS A MICRO -PRINT S(GNAIURE LINE AND BORDER. ABSENCE OF THESE FEATURES WILL INDICATE A COPY.

(FOR A PIER/UNCOVER.ED BOAT IIFI)
I hereby certify that I own property adjacent to b.l �� c- �� �Mci`�%'S 's
(,i me of Property O-ner)
property located at 11 -7 F% U6 /< 5 S T,-
(Lot Black Road etc )
on c14AvAL , Li A4-tQ�tttc Al�_ , N.C.
(Waterbody) (Town andlor County)
He has described to me, as shown below, the developr�ent he is proposiv; at that
location, and, I have no objections to his proposal. I understand $'at a pier/uncoverex: boat lift
must be set back a minimum distance of riftern feet (15') from mylarea of riparian accr,s unless
waived by me.
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I do not wish to waive the sc back requlre;rtent.
Nov
_ I do wish to waive that setback requirement.
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•------------------------------------— —. -- ------ _.—'
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DESCRIPTION A-ti-D/OR DRANVENG OF PROPOSED DEVELOP? ff—N
("To be fined in ay individ- uzd pirpos-ing dere 1,pmerzr)
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Tint or Type Name
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Telephone Nurnb+r
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Date:--
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(FOR A PIERIUNCOVERED BOAT I IFI)
1 hereby ce;•tiify that I own property adjacent to _ 's
(N me of Property O Suer)
property located at _ l l 7 17 & 06 IC S ,S'?'P2 iF, 7 _ -
(Lot, Block, Road, etc.)
on HR/Q KAbc: Crf nr /3 L in J� f /a,, +I c Pa ck CAP-T fff 7- N.C.
(Waterbodv) (Town andior County)
He has described to me, as shown below, the developr�ent he is proposi11, at that
location, and, I have no objections to his proposal. I understand Viat a pier/uncoveref'. boat lift
must be set back a minimum distance of riztern fe-et (:5') from my area o
waived by me.
' I
I do not wish to waive the seiback requirement.
I do wish to waive that setback requirement.
i
_+__ DESCRIMON A-N-D/OR DRAWLNG OF PROPOSED:DE`'ELOF.NMNT:
("To be filled inky indi;, luia y; po�Z.zg dove ��pment)
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Signature
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