37542_RAYMOND, MAT_20040220

�J CAMA / -- DREDGE & FILL
GENERAL PERMIT
CNew F_1Modification OComplete Reissue -Partial Reissue
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
Previous permit #
Date previous permit issued
attached.
Applicant Name /"S Y N'Ic #1 d Project Location: County
Address E" ` , Street Address/ State Road/ Lot #(s)
City )r , �'�^ ?IF
State ZIP
;.r.•. ! riv f
Phone # ( ►� ) ,l�S" C�ys
Fax # ()
Subdivision
Authorized Agent `� ; 10.A
City— f u, I{ t Zip
- c `G
❑ Cw ❑ EW
p PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
G d is
Affected
AEC(s): EloEA 1-1HHF
ElIH El USA El N/A
Adj. Wtr. Body. `t14 I ' Zc, ,
' (nat /man /unkn)
❑ PWS:
❑ FC:
i
Closest Maj. Wtr. BodyU' vci
ORW: yes / no PNA
yes / no Crit. Hab. yes / no
Type of Project/ Activity
(Scale:.
Pier (dock) length
Platform(s)
SAV:
Sando
Mor
Phot
Waiver Attached. yes no
A building permit may be required by:
Notes/ Special Conditions
on back regarding River Basin rules.
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El See note
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- -
,
I
or Applicant Printed Name
Permit Officer's Signature
2.1t. c y S;s•(��
Signature ** Please read compliance statement on back of permit
I
Application Fee(s)
Issuing Date Expiration Date
�r
Check # Local PlanningJurisdiction
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 consistentwith 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 / 1-888-411COAST
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

AL*916W
MAT C RAYMOND III 2518
NCDL 7196487 PH 910-455-5995
106 FAIRFAX CT
JACKSONVILLE, NC 28540 ! - CI , L/ 66-21/530
CT / BRANCH 77594
Date
Pay to the C
Orderof_y $ JQ.
Dollars
WACHOVIA
Wachovia Bank, N.A.
ACH R/T 053000219 For 6t-4c 375— -- _ �� Ll2---
,:0 5 3000 2 19i: 10 4 LB 4 4 3B 2 ?BOII' 2 5 1B

ADJACENT RIPARLXN PROPERTY OWNER
(FOR A PIERAWOO,RING PILIh'GS/ROATLIF IROAMOUSE)
i hereby certify that I own property adjacent to AAAi-i- �mcwzw . ,s
(Name of Property Owner)-- —
property located at _ �'� a bZQA6- to
(Lot, Block, Road, etc.)
(Waterbody)
(Town and/or Countv)
Ni' C.
He has described to me, as shown belaw, the development he is proposing a_ that location,
and, I have no cbjections to his proposal_ I understand that a pier,'moorin2
piiings/boadif /boathouse must be set back a minimum distance of fiftet-i fart (15,) from rev area
of riparian access unless waived by me.
I do not wish to wailve the setback requirement_ FEB 18 2004
R� I dQ wish to wa,Tve that setback re uirement.
DESCRIPTION ANDiOR DRA WNG OF PROPOSED DEVELOPMENT: --
(To be filled in by individual proposing development)
ip
, /�� `
Stanature
Print or Type Name
Telephone Number
Date: 44��

'. ADJACENT RIPARL-'N PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
' 32'
FEB 18 2004
I hereby certify that I own property adjacent to MAV1- 06-yAA0k3 - ,S
(Name of Property Owner)
property located at 10;1- LbG(UE L -NV
(Lot. Block, Road, etc.)
on -130 C-446 ,SO"^4> , in CAf&- C ''gym , 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/mooring
pii.inas/boadift/boathouse must be se: 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 d-Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWP G OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
RaA Ack _ LAC 677^16- Uc AW C.I prc.
E�IS�t �1Lr
a*7!;�774, Z.,
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Signature
Pnnt or -Type Name
Telephone Number
Date:4.14;)pc

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