36717_SEELEY, BILL_20031119

epa^r"`:_
❑CAMA / '11! DREDGE & FILL
%
GENERAL PERMIT
Previous permit#
FJNew Modification El Complete Reissue
ElPartial 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 } i
1YRules attached.
Applicant Name ESA I
Project Location: County
Address _ ��I , i ; ..�
Street Address/ State Road/ Lot #(s) (, {
City -� �.� State ZIP
Phone # ( ) )'r ,l( ` 1 j Fax .# O
Subdivision `} L
Authorized Agent i L((_ �I S
City _ ZIP
Affected - Cw CXW E*TA ❑ ES ❑ PTS
Phone # ( ) --- River Basin
AEC(s): C OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
Adj. Wtr. Body_ _ c-...� (nat Lman Junkn)
_I PWS: ❑FC:
ORW: yes / no PNA yes / no- Crit. Hab.
Close-
s 1" t Mal. Wtr. E3��y_—�
yes / no o'
Type of Project/ Activity L.1
� r
Pier (dock) length {,'
Platform(s)
Finger pier(s)
Groin length
(Scale: )
number
z
Bulkhead/ Riprap length
avg distance offshore
t (J
max distance offshore
! �(,
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
CC
Beach Bulldozing
h � t
Other _
v
Shoreline Length
SAM not sure yes no --
3
Sandbags: not sure yes no,
Moratorium: n/a yes no
Photos: yes 'nod
Waiver Attached: yes no ,
A building permit may be required by:
_ See note on back regarding River Basin rules.
Notes/ Special Conditions
i�
Agent or Applicant Printed Name
Permit Officer's Signature
/
+ I I G , 1
')!Ic.- - (
Signature ** Please read compliance statement on back of permit
Issuing Dates r
Expiration Date
Application Fee(s) Check #
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:
❑ 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.nccoastalmanagement.net
Revised 10/05/01

' ERIC B. ELLIS NCDL 65047 2569
JASA M. ELLIS PH [phone]
205 NOTTINGHAM DR.
MOREHEAD CITY, NC 28557 Date 0� 66 30/1333
Pay to the
Order of
-�-
Dollars 8 �E
FIRST CITIZENS -
' r L First-Cit2ms Bank 8 Trust Company
j BANK Atlantic Boa, B N C. 28512
Trust
www.firstcitizens.com
For 47C .3(017
1:0 S 3 100 300,:00 13 L 71, [,a 7801is 0 2 S 6 9
• GUARDIAW; SAFETY BLUE ESBL

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCO VERED BOAT LIF7)
1-:117, -- / I
I hereby cerfify'that I own property adjacent to , Z- " Z/, t eA/ S
(Name of Pr6perty Owner)
property located at
Block, Road, etc.)
on in 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/uncovered boat lift
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 dg wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fdkd in by individual proposing development)
Signature
Print or Type Name
-2-0 -5
Telephone Number
dQV Date:

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIUNCOVERED BOAT LIFT)
I hereby certify 'that I own property adjacent to,s
(Name of Property Owner)
property located at
Block, Road, etc.)
on e ; . _�;� v , in �, � t ; _ t , % ` ; f / , 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/uncovered boat lift
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 I44 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be jelled in by individual proposing development)
r a
i
Signature
Print or Type Name
�-" J w '
Telephone Number
Date: