39614_ORMOND, PEGGY_20040810

CAMA / '_ DREDGE & FILL`
GENERAL PERMIT
Previous permit # k
__.'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
D Rules attached.
Applicant Name F , Project Location: County
Address j r Street Address/ State Road/ Lot #(s)
City Z,; C 7 State ZIP
7y * - /cr t- Fax # Subdivision
Phone # (__.) > ( )
Authorized Agent City ZIP
Affected CW C+EW .PTA ❑ ES PTS Phone # River Basin
AEC(s): r OEA ElHHF ❑ IH ❑ UBA = i N/A Adj. Wtr. Body �iiat'/man /unkn)
PW/S: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier
Platf
Finge
Groi
Bulk
W
Basin
Boat
Boat
Beac
Othe
HOMES
IMMEN
NEE
NNE
IN
IN
ME
upon
0
IN
M
IN
MEN
0
MEN
���'i:�W►AC�1�JDNONE
NNE
ME
IM
fig 2
■■■�
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date
Local Plan ningjurisdiction
Expiration Date
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, 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 ❑ 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-B Hwy. 24
Hestron Plaza 11
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.nccoastaimanagement.net
Revised 10/05/01

l
MRS PEGGY G ORMOND
PH. 252-633-1920
1300 NC HIGHWAY 55 W
NEW BERN, NC 28562-8638
2108
017tc
6</
66- 112/53 1
01902
IB311 ^��j
BRANCH BANKING AN() TRUST COMPAN
ADVANTAGE '
�N, BERN, NORTH CAROLINA Y m
a
1 19 30 2C.08 311' 21

AL-29-2004 THU 11:03 AM NC DIV OF COASTAL MGMNT FAX NO, 4
P. 02
ADJACrN''X' RIPARTAN PROPEUIT ' OWNER STATEiVWNT
(FOR A PIER/MOORING I'll INGSIBOATLIFT/I3OA7lIDUSL')
I hereby certify that I own property adjacent to _. . Q a-�.dj-11's
(Name o r ei y Uwr7er)
proltt:'rty located at _ C"L j ): ,` ", 2 a
(Lot, Block, Road, etc.)
on _,.. � v c r in � �. rr1 c� _ _ �,.,. N.C.
( 6V.tte-r booy) (Town mid/or- County) i
I -le has elcscribed to nu:, 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
pilirtl;.SI��OZt11fUI)O�11hUl1.St must be, set back a minimum distance of fifteen feet (15') frottl my Zrtz
of riparian access unless Nvaive d by nit;.
I c14._tyQt wish to waive the setback requirement. ;.
I (1.0- wish to waive that scthack requirement.
l)l',:SCC 11q'ION AND/0R DRAWING OF PROPOSLD I)LVELOPMENT.
n (Tv be filled in hY individual proposing development)
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Signature
}Tint or Type Name
Telephone. Number

j • , • Ji-29-2004 THU 11 : 03 AM NO D I V OF COASTAL MGMNT FAX N0, 4
P. 02
A'DJACEW RIPAPJAN PIZOPERTY OWNER STATENWN r
(MR A t'IFR1Af00R11VG I MINGSIBOATLIPTIBOA MOUSE)
I licroby certify that I own property adjacent to _ ' r ,-tals
(Name of ' p rty Owner)
projx"rty locatcd at .—'�� lam" a`�'... r r NzdA, �2c,C cp
(Lot, Block, Road, etc.)
on— _, in m %C c; N.C,
(6V lc I�ody) '(Town and/or County) i
Ile has &scribed to nm, 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
pilir7i;S/bo;ttliftlbc�a�houst. must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by mt:.
I clo...ttol wish to waive the setback requirement_ ;
j1 1 ,0c) wish to waive that sctb,lCk requirement.
M"SCRIP"f)ON AND/OR DRANVING OF PROPOSLD DEVELOPMENT;
(To be filled in by individual proposing development)
P(ctce Cl
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Print or Type Name
"Telephone. Number
Date: -Pt