39687_MCDONALD, JAMES_20040830

L�CAMA / ❑ 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
F-, Rules attached.
Applicant Name°fft�''��� /�j` `�� �/rlyd} Project Location: County_
Address //V Z "qa E Street Address/ State Road/ Lot #(s)
City tj <' - L State VC ZIP
Phone # ( ) ? VL,- % uU Fax # ( ) Subdivision
Authorized Agent .� e City _ZIP
CW - EW PTA ES PTS Phone # ( ) River Basin v-t
Affected —— UBA N/A - ,a`t a�n un
AEC(s): OEA HHF IH Adj. Wtr. Body 'k'n)
-
s F
ORW: yes / noPNA yes / no Crit. Hab. yes / no Closest Mal. Wtr. Body "
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s) _
Groin length
number
Bulkhead/ Riprap length
avg distance offshore -
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length 7 -r =
SAM not sure yes
v -
Sandbags: not sure yes
do,,
Moratorium: n/a yes
6
Photos: yes
Co
Waiver Attached: yes
Ing
A building permit may be required by:
Notes/ Special Conditions
t Yt� Y1i1
Agent or Applicant Printed
Signature Please rea,
(Scale: )
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14
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41 i ,
77
See note on back regarding River Basin rules.
Permit Officer's Signature
� l
k of permit
s� .-
Check #
Issuing Date Expiration Date
Local PlanningJurisdiction Rover File Name
Application Fee(s)

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 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

JAMES C McDONALD JR
NCDL 1499840 PH 252-240-1380
4911 HOLLY LN
MOREHEAD CITY, NC 28557
Pay to the /
Order of
5054
Date /
66-30/531
137
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fiRST CITIZENS 137 CI"ll�l� bQf t
BANKBANFirsl-Citizens Bank 8 Trust Company
Morehead Cily. N C. 28557
www.firstcitizens.com
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i:053100300I:00 1317L,75 �iii' 0505L, _
CUARDIANA SAFETY BLUE DEBL
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ADJACENT RIPARIAN P ERTY .OWNER. STATEMENT---
- (FOR A PIER/MOORING P... fGSIBOATLIFT/BOATHOUSE) _
I hereby certify that I own proper : Acent.to 01
�efr 's
(Name of Pro erty Owner)
He has described to me, as shown 'r el. the development he is proposing at that location,
and, I have no objections to his .osal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set bacl Haim distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive C- s
I list wish to waive that
DESCRIPTION AND/OR D:'.
(To be filled in by : c.
requirement.
- - - - - - - ------------------------------------------------
C OF PROPOSED DEVELOPiNIENT:
:�c! proposing development))
P
Signature
Print or Type Name
_z S'z --7z(� -97g6
Telephone Number
Date: Z-Y�-c

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to f1i V � F - J s * M ON' s
(Name of Property Owner)
property located at fib�10'-
(Lot, Block, Road, etc.)
md� �n�� , N.C.
on /��Y+L� f-�� vi`NnI F � , in
(Waterbody) (Town and/or Co nty)
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.
✓ I i� wish to waive that setback requirement.
- - --
- - - - ------------------- -
DESCRIPTION AND/OR DRA«'ING OF PROPOSED DEVELOP 18Nt- --`f
(To be filled in by individual proposing derelopmenl)
-------------------------------------
Sign ture"
� Q
nC Ci
Print or Type Name
'7 r2- �'- - o
Telephone Number
Date: �' C

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
at I own property adjacent to
I hereby certify that p p._ .y. J
(Name of Property Owner)
/
property located at / LI Mi C
_ (Lot, Block, Road_, etc.)
on1 �y)
inNC( aterbod(Town and or Co nty)
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.
I ism wish to waive that setback requirement. 1C04
__________ _ _ _ ___________T__-_______-_-______-__-______-_-__-_-__-______..___-__.____---___-__________--__
DESCRIPTIO` AND/OR DRAWING OF PROPOSED DEQ:Cit'4 DCDM
(To be filled in by individual proposing development)
.dZZ2 5 lz-i
Print or Type Nam
2Z� '—'/`L L/
Telephone Number
Date: U

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