42480_FULCHER, JOHN_20050802

4 -1 CAMA / !-J DREDGE & FILL
GENERAL PERMIT
Neal DModification (Complete Reissue f_'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 15A NCAC
i!
h/ ;l
Previous permit #
Date prev4ous permit issued_
Applicant Name_ r Project Location: County
Address �? '^t /r f> ' Street Address/ State Ro/a7,,
City_ � r'2� / 7 �: �:i� � ( �� State ZIP
�ot #(s)
[Rules attached.
VAN
Phone # ( )
? j k Fax # ( )
Subdivision
—
Authorized Agent
City P C,f—
ZIP
-; CW
D EW O3 PTA ElES ElPTS
Phone # (- r ) ^
�� River Basin
Affected
-1 OEA
AEC(s):
i i HHF ❑ IH CI UBA ❑ N/A
Adj. Wtr. Body
7oux `� (nat Iman /unkn)
CI PWS:
❑ FC:
Closest Maj. Wtr. Body
�.
ORW: yes / no
PNA yes / no Crit. Hab. yes / no
Type of Project/ Activity
(Scale: )
Pier (dock) length—_ _
f
Platforms)__.,.---
Finger pier(s)
i\'
Groin length
I
number
D
Bulkhead/;Rtprap length:
avg distance offshore i
l
max distance offshore
'
Basin, channel
' -
•r�
cubic yards
Boat ramp
\i
\ i�r_ ` t' :
Boathouse/ Boatlift
_ _•"`' _ { .,
��_
Beach Bulldozing
-- -- -
Other
Shoreline Length
SAV. not sure yes no:
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes
Waiver Attached: yes t no'
A building permit may be required
by:
See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name Permit Officer's Signature
Signature Please read compliance statement on back of permit Issuing Date 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, 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 _� 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 howto complywith 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

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit:
Address of Property: �� 5- /2t�US ,r'r V-D
P Y�
,59
(Lot or Street #. Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
o objections to this proposal.
I haven � P P
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestron Pla:,a H, 151-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certifted Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of IS' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
_ — I do not wish to waive the 15' setback requirement.
-�^vim
Sture L Date
Cr/G7/7. f i'A f
Print Name
13(e - ?? �
Telephone Number With Area Code

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 'Glia L) EL�auCziQ 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on Ca&E !S3tjA/p , in s � cL ��?' � T COO , 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 befilled in by individual proposing development)
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Signature
ow
Print or Type Name F
3 7 3 T /y'Y
Telephone Number
Date: 2 — / 6)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ;&Ai L'2 r'l,.o—RE' is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc:)
on _CaQE * 2iCt11�17L , in �,F} 2—.y—,L 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)
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Print or Type Name
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Telephone Number
Date: �% -- C'O`c r —

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JOHN W FULCHER NCDL 11 low
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PATSY FULCHER NCDL 271�
PH. 252-222-3167
w 809 LORD GRANVILLE DR A
MOREHEAD CITY, NO 2157
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Morehead City, NO 28557
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