41302_FLORA, MATT_20050412

JCP{MA / i DREDGE &FILL
GENERAL PERMIT
C_'New ['Modification ]Complete Reissue - Partial Reissue
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
Previous permit # L.
Date previous permit issued j
O Rules attached.
Applicant Name i } I4 TT }' �U'Project Location: County '
Address t�OX Street Address/ State Road/ Lot #(s)
City State V �L.,ZIP.�-23 6 q11 7T
Phone # ax Subdivision
Authorized Agent w/i�i `Z �1�7 City `?;��- �;� t'�r��j` ZIP 17
❑ CW �W �TA El ES ❑ PTS Phone # (_ ) " L, r �? River Basin 23
Affected [l OEA ElHHF 7 IH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body_ 6 (nat [man /unkn)
❑ PWS: Ll FC:
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
Boathouse/ Boatlift
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
no
A building permit may be required by:
Notes/ Special Conditions
(Scale: )
See note on back regarding River Basin rules.
Agent or Applicant Printed Name Permit Officer's Signature
Sign ture Please read compliance statement on back of permit Issuing Date Expiration Date
Z04/
-
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules F� Other:
J 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 / 1-888-4RCOAST
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.nccoastaimanagement.net
Revised 10/05/01

04/04/2005 23,43 2522232105 4 912527277043 N0.264 P02
Ap,- 05 OS 09:50a Inspection Dept. 7?7 7043 P•2
r
ADJACENT R TAR.IAN PROPERTI O"'M .STAMNMI NT
(FOR A PIERIUNCO VERED BOAT L
I hereby certify 'that I own property adjacent to
property located at za (f) la-, *L A., 14 �-,
(Lot, BE , Road, etc,)
on /)% in����✓� U
(Wa erbody) (Town aad)o
He has described to me, as shown below, the develof
lu auon, and, I have no objections to his proposal. I Understand
must be set back a minimum distance of fift=n feet (15') from m
waived by rte,
1 do not wish to waive the setback requirement.
I dQ wish to waive that setback requirement.
of ]Property Owner)
L N.C.
ount:v)
nt he is proposing at that
t a pierluncovcred boatlift
ea of riparian access unless
----------- I ------------------------------------------- - --------------------
DESC)ltUMON AND/OR DRANNTgG OF PROPOSEY EVLUOPM.ENT:
(I-o be JuxPd in by� indiiidw l proposing deva pment)
OKI, —4,-- Al. 0 cool S".
----------------- ------------------------------------------ ---------�-
rin; or Typ
�Telcphonc h
X Date: -4

04/04/2005 14:36 FAX [phone] ACCESS Medical Dev. Q 002
APR-01-2005 10:35 FROM:ALLAN SHELOR REAL ES 252 247 0759 TO:919 828 1518 P.2
i
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify 'that I own property adjacent to , e" s
(Name of Property Owner)
property located at Z60)
(Lot, Bloek, Road etc.)
on A,11A in 4/V5, 1►/7-' c 6k1fe— Z , N.C.
(Wa erbody) (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 d� wish to waive that setback requirement.
DESCRIMON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be fiUed in by individual proposing development)
7G coo o e'> ra �/ s✓ 1� 7 �Fr `
e r a v iv Z
✓/,�j�. f.a � Tom' b �`� �7 .� r�J14 o � r
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X ?I'. CK�"
Signature
Willi Q.t.m `T. 'SM; -�
Print or 'Type Name
x(9Ig)82-� aIS lb
Telephone Number
X Datc:

ERIC B. ELLIS
2948
JASA M. ELLIS PH [phone]
205 NOTTINGHAM DR.
O� 66-30/531
MOREHEAD CITY, NC 28557
Date 133
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