42780_GRIFFIN, JAMES_20050901

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-]CAMA / .DREDGE & FILL
GENERAL PERMIT
C!New EiModification EComplete 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 15A NCAC
421780
Previous permit fit
Date previous peued
Applicant Name Project Location: County
Address ^ / �� j w Street Address/ State Road/ Lot #(s)
City ✓J State N ZIP
.,-
0 Rules attached.
-'r
Phone # ( ��)
f Fax # ( )
Subdivision
-� I f �' ' `
Authorized Agent
"
City sir^ ;
{
''"^,' /✓ ZIP
CW
—' EW (�A ❑ ES ❑ PTS
Phone # (_
) River Basin '�'`-��='�'
Affected OEA
AEC(s):
J HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
�
��� ((nat�man /unkn)
-1 PWS:
❑ FC:
ORW: yes / no
PNA yes`/ no Crit. Hab. yes / no
Closest Maj. Wtr. Body�r�E
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
!! i.._.... .......
Shoreline Length %' b
SAV: not sure yes no,
Sandbags: not sure yes
Moratorium: n/a yes no
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
I
Agent or Applicant Printed Name
f.10 a, ^—
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
(Scale:
[? See note on back regarding River Basin rules.
PerrhitOttic r'§Sighature
Issuing Date Expiration Date
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 consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
EI 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 (910-796-7215) for more information on how to comply with these buffer 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
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
400 Commerce Ave
Morehead City, NC 28557
202-808-2808/ 1-888ARCOAST
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
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

f.
■ Complete items 1, 2, and 3. Also complete A. Sign
item 4 if Restricted Delivery is desired. X
■ Print your name and address on the reverse
so that we can return the card to you. B. Received
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Printed Name)
D. Is delivery address different from item 1
1. Article Addressed to: % If YES, enter delivery address below:
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❑ Agent
❑ Addressee
Yes
No
3. eRegistered
ice Type
ertified Mail ❑Express Mail
❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 2510 0003 2066 4990
(Transfer from service
PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVI r ; T-=me First-GlassAd3il.w�
j ' 'r P'66� ge & Fees Paid
/ LISPS
'Jd� Permit No. G-!0 ID
• Sender: Please print yggr, OaMe, address, and ZIP+4 in this box •.
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at www.usps.coft
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Postage
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Certified Fee
$2.3Q
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Return Receipt Fee
$1.75
Postmark
Here
(Endorsement Required)
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Restricted Delivery Fee
(Endorsement Required)
to.(10
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1�E'`I)5�?II115
Total Postage & Fees
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Sent To
or PO Box No.
City, State, LP+4
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PS Form :r, June 2002

CERTIFIED MAIL — RETMN RECEIPT REQUESTED
DIVISION OF COASTAL li��;AGEV�NT
ADJACENT RIPARIAN PROPERTY OWNER itiOTIFICATIONIWAIVER
FORM
Name of individual applying for permit: JA-6�jk5 /�. (> RJz-"%/1
Address of property: % 2 L oA/19 1/i45,41 OAZA
(lot or street #, street or road)
SA k O 1 /Co e, P
(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.
) / I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Ave., Morehead City, NC 28557 or call [phone]
within 10 days of receipt of this notice. No response is considered the same as no
objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or sandbags
must be set back a minimum distance of 15' 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.
r
gnattue Date
Print Name
Telephone Number With Area Code
{.,' .-Tvried mail ri !!u u rt—tv4pl,. Yt',qut:Stt-1 ; dj. 4.k-eNt d"<ia.?i"an
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ���� �. &I 6�f� -s
(Name of Property Owner)
property located at /2 1� /—o*c- "jy &AD
(Lot, Block, Road, etc.)
on f-! //� �- C A L-��.�' , in y pi`C,,� l �-� �� 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):
E
Sifnature
i. R A 1! AM
Print or Type Name
l'
Telephone Number
Date: - 7

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Alx/� XT 405
A 41P 120 �j?
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Pay to the
Order of _
JpMrS H GRIFFIN
' C L 2536355 Ph.252-745-7550
127 Longview Rd
Bayboro, NC 28515 � ����
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WACHOVIA
Wachovia nk,
ACH R!T 2 9 O
For i/ 1\
580 2 L0084
1:0 5 3000 2 191. LO
1731
66-21/530
I BRANCH 77e19
$ jDo�t�/
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