40067_FARLOW, W GARY_20041020

❑CAMA / E. DREDGE & FILL
GENERAL PERMIT
Previous permit#
'New ILIModification CComplete 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 o
rr !
6- e,4 I' `/ f U ✓
E5 Rules attached.
Applicant Name `
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
City .; :'`� State (J c ZIPS
Phone # (� j �) ��� l r 6 / Fax # O
Subdivision
} G
Authorized Agent
City ZIP 1
Affected ElCW DEW � PTA ES - PTS
1j�
Phone # ( ) r River Basin / " e''�
- OEA ❑ HHF - IH -,i UBA - N/A
AEC(s):
'� ,
Adj. Wtr. Body Y at/man /unkn)
C. PWS: I-1 FC:�
c ,
ORW: yes / no PNA yes / no; Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity`
Pier (dock) length -
Platform(s)
Finger pier(s)
Groin length -
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouseji Boatlift
Beach Bulldozing —`n'r /r Y
1{!
r
Other
r 9;
Photos: yes no
Waiver Attached: yes
A building permit may be required by:
Notes/ Special Conditions
J
U�.
Shoreline Length � U
SAM not sure yes `no ! —_—
I
Sandbags: not sure yes kc� f
Moratorium: n/a yes a �(
le Y F,6 R LG
Agent or Applicant Printed Name
Signature Please read com fiance statement on back of permit
Application Fee(s) Check #
(Scale: )4,,\I, )
Y l —" ee note on back regarding River Basin rules.
Issuing Date +Expiration Date
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, 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:
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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
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 IO/05/0I

1253
GARY FARLOW � sa-��sio VA
1266
P.O. BOX 65 Date
MERFM7, NC 28556-0065
E
Bankof America
ACH R/T oSI000017
Memo goQTG/ltT/-rid c
I:0 5 L0000 L 7l: 0000 2 68 L8 2 1
/G(� Mars 8

■ Complete items 1, 2, and 3. Also complete
{ item 4 if Restricted Delivery is desired.
l ■ Print your name and address on the reverse
j so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
COMPLETE•ONDELIVERY
A. Sign
X7dt4eOZ _7
TC }
ddressee
B. ad b (P ' a Na e) Date of Delivery ?
-o
D. Is delivery address dill ' nt rom m i? ❑ Yes
If YES, enter delov Iaddress elow: ❑ No
I
3. Se ce Type
Certified Mail ❑ Express Mail {
❑ Registered ❑ Return Receipt for Merchandise I
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
i 2. Article Number
(Transfer from service label)
PS Form 3811, August 2001 Domestic Return Receipt
S,
102595-01-M-2509
X :6'

UNITED STATES POSTAL SERVICE 11111
• Sender: Please print your name, address, and Z +
1 T T,
c,,
(1;,,5
j,,,l C,
First -Class Mail i
Postage & Fees Paid
'LISPS ic .�Permit No. G-10,
in this box •

• • 1
ADJACENT RIPARIAN PROPERTY R STATEMENT
(FOR A PIER/MOORING PILINGS/ OATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ] . GAgV EAP-LOW 's
(Name of Property Owner)
property located at 96. 3 70V)N,5111f FLD.C.MlCEE DEED &C< 968 PAGE IS,I
(Lot, Block, Road, etc.) PAMLICO CaV"T f' RE6/5-rRY
on �,�`� JPll�BR _ . in N.0
Town and/or County);
`(�Vaterbody) ( y _
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..
V, I do not wish to waive the setback requirement. t
I do wish to waive that setback requirement.
---------------------------------------------------------------------------------------------------------- --
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
--I (To be filled in by individual proposing development)
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Signat e
Print or Type Name
elephone Number
Date: