37578_PROCTOR, PHYLLIS_20040308

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❑CAMA / _:DREDGE &FILL T
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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 I SA NCAC
E] Rules attached.
Applicant Name Project Location: County i,4
Address
State ZIP
Phone # Fax # ( )
Authorized Agent Y j' i (' V 1 11 <1
Affected ❑ CW I� EW EATA ❑ ES ❑ PTS
AEC(s): ElOEA ❑ HHF ❑ IH ❑ UBA ElN/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Street Address/ State Road/ Lot #(s) d
Subdivision
City - ZIP
4
Phone # River Basin
Adj. Wtr. Body _ (at /man /unkn)
Closest Maj. Wtr. Body—T--� _
Type of Project/ Activity
( Scale:
��
W
Pier ( '���
Platfo
Finge
Groin
Bulkh
,avg distance offshore__
I-nax distance offshore -
Basin, channel
yards
Boat
Boat
Beacn Bulldozing___
Othe
ME
EIIIIII
ME
Shor
SAV: not sure yes no
Sand lags: not sure yes no
Mora�orium: n/a yes no
Phot
wait/ a
A building permit may be required by:
Notes/ Special Conditions
INIM
rules.
on back regarding
River
Basin
va
❑ See note
■
Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit **
Application Fee(s)
Issuing Date
Check# Local PlanningJurisdiction
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, certifythatthis 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 / 1-888-4RCOAST
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.nccoastaimanagement.net
Revised 10/05/01

r` 2632
ERIC B. ELLIS NCDL 65047 66-30/531
JASA M. ELLIS PH [phone] D 4 133
205 NOTTINGHAM DR. Date
MOREHEAD CITY, NC 28557
Pay to the {�
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Adanhc Boach, N C. 28512
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
",P
z -��2 'I hereb certif that I own ro ert adjacent to LLIS U s
Y Y property Y J
(Naibe of Property Owner)
property located at Ary
on bO UjE- ( 00009
(Waterbody)
SI�oP-E- (�►2-to(f�
(Lot, Block, Road, etc.)
in S0 P'o S , N.C.
(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
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 S�4 wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
---------------------------------------------------- ------------- - ------------------------------
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Signature
Print or Type Name
Ian-CZS'31
Telephone Number
Date:

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112 ua 2004 11'51 E-t.'t 91.9 382 3310 PROCTOR FLOORINC 002
ADJACENT IUPARIAN PROIIEWrY OWNER STATEMENT
(FOR A PIERIMOORfNG P/Lt1NGS/BOA77-'FT/'ROAT"OUSE)
�2
that I own »b rt adjacent to �.lS .�1� s
i hereby certify 1 Pe Y
(N a of Properrt.y Owner-)
property located at -,. 0 7 jf�afZ f�1e - -- '
(I,ot., Flock, Road, etc.)
fr ti
('Wat.erbody) _ -- _ (Town nnrllor Cotinty) --,
Re has descrit) i To n-,e., as shrown below, the developtaent he is proposing at that lcx:ation,
and, I have t)o objections to his proposal. I understand that a pier/mooring
pilings/boatliftlboatbouse must be, wet back a minimum distance of fifteen feet. (15') from rr►y area
of rip
arian access unless waived by me-
I d0 1WJ wash to waive the setback requirement. -
I du wish to waive that setback requirement.
------ ------ •----.
IMSCRIPTIOIN AND/OR DRAWING OF PROPOSLD DL+'b">vU. )PMEN --
(To he filled ire by individual proposing development)
E_.. �0 ,� �� C� � o�Y,r. r
siKnatur
Print or Type Name
Telephone Number
Date. _... �2 4