33913_COULTER, BILL AND BART LEWIS_20030403

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C'CAMA / ❑ DREDGE & FILL a
GENERAL PERMIT Previous permit# y
DiNew ❑Modification DComplete 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 a�
❑O Rules attached.
Applicant Name
i
Address
City i:�% k."� 4c.� l ° State ` ZIP
Phone#F.a�x.,#(�)
Authorized Agent
Affected ❑ CW 5 E'W [PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS: ❑FC:
I'll.
ORW: yes / no PNA yes / 6o Crit. Hab. yes / no
Project Location: County '; t-1;c'
Street Address/ State Road/ Lot #(s)•.;
Subdivision t j A ; i L
City ZIP
Phone # ( )_ River Basin j ; �(C✓F-s c
Adj. Wtr. Body ijai.. `._ , c t • i i n ]man /unkn)
Closest Maj. Wtr. Body et ";-S
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Agent ojr Applicant Printed Nam fI/
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing ate Expiration Date
Local Planning Jurisdiction Rover File Name

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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 El 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
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
151-13 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

ru-rat`,L-IiN VROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to ` ' L ( Cau r s
(Name of Property Owner)
property located at
(Lot. Block, Road, etc_) '
on Pe�T0'r"E
in _
(Waterbody) (Town and/or County) ' N.C.
He has descl-jibed to me, as rown below, the developmer,: he is propos -- art�`,ac location,
and, I have no objections to his proposal. I understand tha: E pie ;'mooting
PaLriQsiboadifrlboathouse must be se: back a minimum distance of fifteen fee; 5 i:_ my area
of rparian access uniess waived by me.
I n n wish to wa_'�-e the setback requiremeac.
I da wish to wive :gat setback recuirement.
DESCRIPTION AND/OR DRAWE';G OF PROPOSED DEtiELOP E-N- ":
(To be filled in by individual proposin; development)
Signature
P.;nc or Type Nan;e
(,,z5z Z�zr-O3 3D
Te'.eohone N:,m be7
Dare: 3-Z� .03

�DJACE'NT RIPARL;.i'ti PROPERTY OWNER STATE_IENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby ce:rcify that I own property adjacent to � >rJ
is
(Name of Propertv Owner)
Property located at
(Lot. Block, Road, etc_) '
on JE'c , e - , in
(Waterbody) , N. C.
(Town and/or Coun v)
He has desclioed to me, as shown below, the development he js propos - = a_ t�,at location, and, I have no objections to his proposal. I understand tha: a pier; mooring
pilings;boadift/boathouse must be se: back a minimum distance of Freon fer: tom my area
Of access unless waived oy me. ( )
I n� wlEh to wage the setback requiremen[.
Ida wish to wwe t'.a1 setbac.{ re_>>jr"`nent.
DESCRIPTION AND/OR DRAWENG OF PROPOSED DEVELOF�fE\T:
(To be fi%led in by individual ProPosiizg development)
JJ�<uo
Signature
, fa
P:,n[ or T vpe Nar„e
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Te'.zpnor,e Urnbe-
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