38890_ROUSE, WAVERLY_20040623

-]. CAMA / ❑ DREDGE & FILL �r� r k 'gr
GENERAL PERMIT //' Previous j"
permit #
CNeW -]Modification -]Complete Reissue -]iPartial 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
J Rules attached.
Applicant Name E, " 1-
Address
"'
City
State ZIP
Phone # ( )
Fax ()
Authorized Agento
Affected CW
❑ EW
[SI-PTA ❑ ES ❑ PTS
AEC(s): —1 OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
PWS:
❑ FC:
ORW: yes / no
PNA
yes / no ; Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ---ZIP
Phone # (_) River Basin
Adj. Wtr. Body -` {� ' ` `- ` (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
)
(Scale:
i"
'
Pier(
P1at)rm(s)___—­
Finge pier(s)___
Groi
Bulkhead/
-.vg distance offshore
max distance offshore
Basin channel
zubic yards___
Boat
Boat
Beac t Bulldozing
Othe
HEAROMMI
MMEMOMIN
mom
MEMOS
PIP
-am
ME
Shor r-lineLength
SAV: not sure yes (,no
Sand lags: not sure yes -no
Moraorium: n/a yes no N
Phot s: yes no
Waiv, a
A building permit may be required by:
Notes/ Special Conditions
0
MEMO
1111161
INININE
MWANEM
MON
Elm
"a=
MENNEN
E
IN
M
t
Y
See note
on
back regarding
River
Basin
rules,
Agent or Applicant Printed Name
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Issuing Date Expiration Date
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
landowners).
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.amlico River Basin Buffer Rules ❑ Other:
ZA'e'use 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 / 1-888ARCOAST
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

W. C. Rouse NCDL 4670958
Special
409 Lilliput Dr 252-635-5140
New Bern, NC 28562
66-30/51 4421
23, ZPO�
r,w r u N�'UF R
()RrnR ui $ �� _�
LARS
k` nR.Sr CITIZENS
S BANK FilVCn—ns Bank & Trust Company
New Born, N C. 28563
www.flrsiditrens,com � ,
�. 531003 0i:004407666999iie 04421

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
oW •c.)
I hereby certify that I own property adjacent toyJAJeeLJ 1 P1�66Y s
(Name of Property Owner)
property located at 40 Li t—oyo-r 0(2-i VE ,
(Lot, Block, Road, etc.)
on blZICEE D CJ-EEK- , in CIW(f�t4 CO t4 i I , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
t;
ID' I
- -)N1F ilLrnlG Uvt i
0 \1 t.
f�MU. 10 FT
Signature
Print or Type Name
Telephone Number
Date:— ! C7�,'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to y4AVal-Y IPEec'-� r�OlJSE's
(Name of Property Owner)
property located at N Lu LL l N l E
(Lot, Block, Road, etc.)
on 6V-1 a�V— , in
(Waterbody)
cg&VG'4 CcvtqT-/ , 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.
DESCRIPTION AN7D/OR DRAWING OF PROPOSED DEVELOPINIENT
(To be filled in by individual proposing development)
�0pA0YY0U� kk"-
�47
APp9ox,
J__________________
----------------- 7-
Pr�►�C� ou��
to rf.
X2,P
Signature `
Print or Type Name
Telephone Number
Date: G 3 d