40383_GORTON, LEONARD_20041129

F! CAMA / ! ' DREDGE & FILL
GENERAL PERMIT
EINew ' Modification —.'Complete Reissue L�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
�� L
revious permit #
Date previous permit issued_
1 Rules attached.
Applicant Name (� <; ? ! `' ' Project Location: County__--„_ -
--
Address_ )"^ r r Street Address/ State Road/ Lot #(s)
C' � '` `� ``' � ` S t ZIP , _: _ , . , .� � • .
4.w'83
— e
Phone # ( )
Fax # ()
Subdivision
/
Authorized Agent C"
City ` ` `"` ' "`�
ZIP
— CW ❑ EW
[E- PTA ❑ ES _; PTS
Phone # ( )
River Basin
Affected
❑ OEA [IHHF
AEC(s):
[IIH UBA N/A
Adj. Wtr. Body _
✓l w
(nat /man lunkn)
Ej PWS:
❑ FC:
Closest Maj. Wtr. Body
P
ORW: yes / no PNA
yes / no Crit. Hab. yes / no
Type of Project/ Activity
(Scale: )
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,: /3
Beach Bulldozing
Other
Shoreline Length
SAV: 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
-T7
J ; s_1zf
)-Ark-1 AJ-k,�
Agent or Applicant Printed Na e
Signature Olelse read compliance statement on back of permit**
Application Fee(s) Check #
See note on back regarding River Basin rules.
�Kermit Off[€er's Signature
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, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
J Tar- Pamlico River Basin Buffer Rules 0, Other:
I 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 / 1-888ARCOAST
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-390I
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

SUATPC
15=800
000
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C.O.D. NO. OR r
U9['D FOR 14

ADJACENT RIPARIAN PROPERTY pWNER STAT E.MYNT
(FOR A PIERIMOORMG PIL.INGSIBOAT1IFT1804THOUS' )11+�
cectrf that i own property adjacent t<, ��—'►✓ — — s
t hereby Y Properly Owner)
(Name of Prape Y
property located a :4-r
_._
(Lot, Block, Road, etc.)
(Wale--rbody) (Tawn &anCot►ntyi
(Wr�te
fie has described to me, as s`towr below, the development he is proposIr19 at that Ioc.at►or.
and, I have no objections to his proposal 1 understand that a pie0mooring
pilingSjb0at1if1fboathou%C must be set back a minimurr. distance of fifteen feet ('15`} from My area
of riparian access unless waived by me.
to waive the setback requ irement,
1 dQ wcsh to waive that Se hAck regjwreinent
DES CRIPTIVN AND!OR DRA,NYIN.G OF PROPOSED DEs ELOPMEtiT�
lj4 A dc.- G A N Q L
n �132�t��irr
it
---- `[1.- - -
nature
Print or Type Name
01
Vim= Z - J ___--
Telephone Number
Date:

ADJACENT RIPARIAN PROPERTY OWNER 9-rATFI'xE'vr
(FOR A PIER/AIODRING PII_ ItvGS180ATI: t'FT/BQ jyN���yISE D I'%'
1 herebycercif that I own property aactnt Io
Y dj(Narne of properly 4,vner)
ny Vc�catcc; at %`-'L� I �..1_s�._..=1 � � ��7'�c�-wru•..._,'s�_.�G_-�__-.���-- =�� -� "-��c..<
-
(Lot, Block, Road, etc.) /
on �Li:
f 1$>�=_.��— -� in _J_.5;.N (' .
' �` (Z awn and' Go1,nI yl
(Waterbody)
l fC to r+ie, a5 shover below, the development he is propasirIg at that {o�.at�un,
ng
objections to
loback a minp�»urr c+ slancc ofef ftcedn fcta(t } from t at
and, I have no objeGt
pllingslboalliftl'boathouse must he
of riparian access unless waived by rne.
_ I dCLn4I wish to W$lve the setback regwreincnt ,
1 wish to waivC than SC'.``nck regwrement
............
DE` cRiPTIVti AND/OR DRA%VING OF PROPOSED DEVELOPMEN"
M A d (z C� A N Q I--
elr IYV5
pr. PCSr ' �l �t.A
Signature
print or Type dame '
Telephone Number
Date. __>>/ �y�Q.1— ___.___._._.____.._