42747_HILL, CLIFF_20050923

]CAMA / ,--] DREDGE & FILL /O tP
(GENERAL PERMIT Pr io permit#
❑New ❑Modification [-]Complete Reissue ❑Partial Reissue D 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
❑Rules attached.
Applicant Name
Address _ 6
1 jj,l-Y
J� I4C. i?,:
City State ZIP
Phone # O ` Fax # ( )
Authorized Agent'
Affected 15CW cs m [- rgTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City. I j ` ZIP �•., r�
Phone # ( ) River Basin
Adj. Wtr. Body ; ` ant /unkn)
Closest Maj. Wtr. Body
Agent or Applicant Printed Name F Permit.Officer's Signature
Signature Please read compliance statement on back of permit Issuing Date Expiration Date
a
ApplicationFee(s) Check# 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:
I-
L -I Tar - Pamlico River Basin Buffer Rules Other:
E1, 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 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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
25 2-946-6481
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,
On,slow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

ADJACENT RXPAR N PROPERTY OWNER STATEMENT
(FOR A PIEW MtOOR.ING MUNGSIBOAxZJJMBOATHOUS�}
I hereby certify that I awn property adjacent to CA ,�i �\ ► l I
(Name of Property Owner)
prupe7y located at i ` ' "`,mi)\- S �0'4 �' R� �
(Lot, Block, Road, etc.)
(Waterbody) (Towns and/or County)
He has de=ibed to me, as shown below, the deMopment he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatliftlboathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do-" wish to waive the setback requirement.
I d4 wish to waive drat setback requirement -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individuetd�ro�rosing development)
0
Signature (/J
Print or Type Name
q/o_-789-583-)
Telephone Number
Date: 11 6 x / 0 5-

ADJACENT RWARXAN PRO:PROrMTY OWNER STATEMENT(FOR A -
O 1' : /:
ihemby certzfy dW t own propcny adjarem tcs L , . ��
(Flame Of Property (?weer)
(Lot, Madg, Road, eM)
on in (waterbwy) Crown and/or Cma�ty3
He,. tea n-bed to toe, 2s doves below, do mr� he is gat t� location,
n�xt'e� i 'u SL` "'3.j�^::&7� ? ° a itnd=wd Thu a TII:861-ng
mtvgf;?P smt back s tu Dam dismal 0c ®f r a fed (15°) fs�sn sty aces
7 n:r- -. 'Ami-.'.'"Yd by e8'»--
_ - , - e s`at sa•"v"'�ia, diAAATE' 'aG UY mvo'i��
r.3t...d3i ai`z. 1t._S.. 3 ewYry Ya•,+o�ri
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Prim of 7yf c Wme
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Donald Oxendine NCDL 3584956
Donna Molina NCDL 8050154
5114 Kershaw Rd. 66-7704/2531
EZShield
Plaud Noted,.,, J-1
Oriental, NC 28571-8723 65
Ph. 252-249-1301
Date
Pay to the
Order of
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STATE EMPLOYEES ,
CREDIT UNION
NEW BERN, NORTH CA L
ROLINA
For
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-- - "y"'d "" U-9 vegftble b.6 i,,. QMARIE SUCHFINK. LICENSED 8Y RICH WISEMAN, LLC,