38397_PYSHER, ROY_20040525

' C7CAMA ❑ DREDGE &"FILL
GENERAL PERMIT Previous permit#
ZNew ❑Modification El 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
❑ Rules attached. 6
Applicant Name Y 5JL,r Project Location: County
Address �LI �� - �` (,cfJ.r� 7,, j Street Address/ State Road/ Lot #(s)
Ci6 It State It ZIP U
Phone # (6 • L `13 K Fax # ( ) Subdivision
Authorized Agent City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # () River Basin
❑ OEA [IHHF ElIH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body__ �✓= S;_ v h .� ' � v,1 (nat /man /unkn)
❑ PWS: ❑ FC:
ORW: i " yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body L, j / c u h cj
Type of Project/ Activity t. 'c. , - ; ., . - c r: ar va v
(Scale: �;G M r )
Pier (dock) length
Platform(s) I TV
Finger pier(s) I
Groin length
number
Bulkhead/ Rira length t^ �
P P St
avg distance offshore < I <
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
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Beach Bulldozing
Other
-
Shoreline Length'`
SAM not sure yes !no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes `na
A building permit may be required by:
Notes/ Special Conditions
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❑ See note
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back
regarding
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River
Basin
rules.
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Agent or Applicant Printed Name
Signature a Please read compliance statd`menton back of permit"
11 ! c . ' p 12A ryl+ . f car✓
ApplicationFee(s) r Check#
Permit Officer's Signature
1 y
Issuing Date Expiration Date
� u . "i f r
Local Planning Jurisdiction 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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
�J Tar - Pamlico River Basin Buffer Rules F -1 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 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

L
r uro►rEvsr�TEs POSTAL MOINTEY ORD ' R 15-ate
POS�d�! SERVIEE® °0°
SERIAL NUMBER YEAR, MONTH, DAY POST OFFICE U.S. OOLLA115 AND CENTS
067
67 2 7 01, 2 i? 2 2 2004-05-03 265570 9,
RIOW224
ONE HUNDRED DOLLARS & 00t *******
AMOUNT
PAY TOLEN
NEGOTIABLE ONLY IN THE U.S. AND POSSESSIONS
S EVERSE WA NING
CLERK
ADDRESS
FR
0004
A 5
USED F ;�-.593-7 -7rRov t'v-
1:00000800 21: 0 E 7 2 70 L 2 2 2 211'

at 1
ADJACENT RIPARIAN PROPERTY OVirIVER STA'TEMEN'T
I hereby certify that I awn property adjacent to —__ _ 's
(Name o Prort O�'ner)
psoper*y located at /a z '�Z�
(Lot, Block, Road, etc.)
on in , N.C.
(�erbo(i;) (T wn and/or County)
He has described to me as shown below, the development he is proposing at that )ocation,
and, I have no objections to his proposal.
DESCRIPTION ANU/OR DRAWING OF PROP'OSE.D DEVELOPMENT
(To le filled in by individual proposing development)
- -----i---
l"""`ate§
Xcs�ITA M
Signature
-
Ptint or Type Name
( iJq— 4(14 — 3233
Telephone Number
Date; S Z 0 `�'