43155_HARPER, JOHN_20051006

❑CAMA / ❑ DREDGE & FILL �
GENERAL PERMIT Prev fo s pern4Tt #
❑New ❑Modification ❑Complete 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 15A NCAC
7 ❑ Rules attached.
Applicant Name / �'� , Project Location: County
Address / = t' (` Street Address/ State Road/ Lot #(s)
City j' ... I l a' State ZIP .,
Phone # ( ) Fax # O
Authorized Agent
Affected EJ CW ❑ EW EwWTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes /rno % Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length I -
1
Platform(s) X
Finger pier(s) M
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
)U o
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
J0 44 Y-roe V
Agent or Applicant Printed a�
Signature Please read compliance statement on back of permit
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body J ` "t '`1 ' (nat /man /unkn)
Closest Maj. Wtr. Body!"
i
i
Application Fee(s) Check #
(Scale:
1�'
.%fy•
1
i
See note on back regarding River Basin rules.
Permit Officer's Signature
i G )_ 6 ¢J-
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, certifythatthis project is consistentwith 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 (910-796-7215) 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/ 1-888-4RCOAST
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

PHONE EE_C &I, L
FOR U/A� OAT' —TIM
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OF
❑ FAX r/ 6(o
RETURNED
PHONE MOBILE 4ZA
YOUR CALL
AREA CODE NUMBER EXTENSION
ASE CALL
MESSAGE
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,oltAIVIE TO
SEE YOU
WANTS TO
SEE YOU
SIGNED S. FORM 40C :):3:)

CERTIFIED MAIL - RETLT-N RECEIPT REQUESTED
DIVISION OF COASTAL, M_-.NAGEIIENT
ADJACENT RIPARIAN PROPERTY O�ti�-ER NOTIFICATION/ VAI-�'ER
FORM
Name of individual applying for permit:
Address of property:
(tot 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, shoul e 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.
Signature Date
Print Name
0111--797 D2 ?? f�-
Telephone Number With Area Code
4CI'�rEiix:°,t ttt;si3 t e a. s .:cg°+ ,3. requc:stW ac jat°ent epar"m

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERAVOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to —w h l 1la y ' ek- -s
-Pt-,
of Property Owne )
property located at /70 0W lea � Pt-,y e
(Lot, Block, Road, etc.)
on ))Pq e -5ruGre , in f / W- 1�140l / 5lW re-5 , 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. I understand that a pier/mooring
pilinas,'boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I Flo not wish to waive the setback requirement.
I d_Q wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AN^D,,OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by indis,idual proposing development)
-------------------------------------------------------------------------- -----------------------------------------
SiQnat re
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Print or Type Name
Telephone Number
Date: �os

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FRANCES R. HARPER SchwAAccess 347
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