41702_JOHNSON, VINCENT_20070506

J CAMA / -i DREDGE & FILL %J� f fi�, i " 41192 G
GENERAL PERMIT Previous permit #
❑New LIModification _.Complete Reissue f_ (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
Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
CityState ZIP
Phone # ( ) Fax # ( ) Subdivision
Authorized Agent City _ ZIP___
Affected ❑ CW '�JW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin
AEC(s): ❑1 OEA "7HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn)
PWS: E FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
Platforms)
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
Shoreline Length
SAM not sure yes
Sandbags: not sure yes
Moratorium: n/a yes
Photos:
Waiver Attached: /yes no,,
A building permit may e required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on backof permit"
Application Fee(s) Check #
Q
(Scale: ) I
See note on back regarding River Basin rules.
Permit Officer's Signature /
Issuing Date Expiration Date
Local PlanningJurisdiction Rover File Name

i
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 [)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 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
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead Citv District
151-13 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

ADJACENT RIPARIAN PROPERTY OWNER STA77EWNT
(FOR A PIRRIMOORING PILINGSIBOATLIF (BOATHOUSE)
f /I ' A
f 'ne JCS
I hereby certify that .1 own property adjacent to , 's
�(Name of Property fawner)
property located at
(Lot, Block, Road, etc.)
in CCC� D.� ..(_(,l✓fr`e , N.C.
a body) (Toy and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, T have no objections to his proposal. i tinder -stand that a pier/mooring
pilings/boatliftlboathouse must be set back a minimum distance of fifteen feet (I5') from my area
of riparian access unless waived by me.
^� 1 do no.J wish to waive the setback requirement.
I da wish to waive that setback requirement.
DESCRIPTION AND/OR DRAW NG OF PROPOSED DEVELOPMENT:
(To be filled in by indi►idual proposing development)
�vo�`
1
Signature
As
Print or Type Name
L4;5a) 7�/,
`Felepho& Number
Date: /

(FDR A PIgRiM00RING pILINGSAROATLIFT/BOATHOUS,I)
s
i #�ei� �;ti►y uhat I own property adjacentJof').A-�0 to ��- � + S
/'\ -
(Nance of Property Owner)
pmperty toctmed at
- (Lot, Block, Road, etc.a af�r
on in I l �
a ody) {'ia aridlor County)
He has &Scri'ad to n1e, as sho%,n hejow, the development he is proposing at that location,
and, nave no objections tc his proposaunderstand that a pier/mmring
l. 1
piiingsllxaatli€iri l souse must see SO back- a mininium distance of Fifteen feet (l5`) from my area
of riparian access uniess waived by me.
t ii wash to waive the setback requirement.
- I -LQ wish to waive that setback: regUirement,
-------------- -
_DJ,ISC:R>!d TION ANDIOR DRAWING Or' PROPOSED j)rvELf?PMFNT,.
(I,0 be j'jllc-al in by irrclividitaf p,•aposing development)
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