40062_KEETER, CHARLES_20041028

CAMA / 1 DREDGE $FILL
GENERAL PERMIT
Previous permit #
❑New -]Modification F]Complete Reissue DPartial 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_
"7
Address (` r �.'
Street Address/ State Road/ Lot #(s)
�r AJ f State ---- ZIP } � ���
% Li i'/ . ,.• C
Phone # ('Y')� . / Fax # O
Subdivision , - ✓ r
Authorized Agent � s i ),: ✓'_,.•i / ,
Cif, a - c l . �.. w �.. ZIP
I— CW N*W 7115TA i ES ElPTS
Phone # ( ) r River Basin
Affected
❑ OEA ❑ HHF ❑ IH UBA ❑ N/A
AEC(s):
`` r
Adj. Wtr. Body ,fn t1man /unkn)
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body
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
Boathous Boatlift '
Beach Bulldozing '—
Other
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
i
eA11'L)I, ) i y J). )(*i /-- I-" )EL
1
-- --- V.
Agent or / plicant PPrinted,, ame
Signature "Please read compliance statement on back ofpermit �� � _4dL•
(Scale: - )
.f. fo ; c.
note on back regarding River Basin rules.
t' z,y�,
PermitOffie r'sSignature
IssuingDate
Expiration Date
lb
Local Planningjurisdiction Rover File Name
Application Fee(s) Check# 0

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:
❑ 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 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:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza 11
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

CHARLES A KEETER NCDL 2906838
PHYLLIS LKEETER NCDL 3323486
6801 Cool Pond Rd Ph 919-845-7203
Raleigh, NC 27613
Date
6206
66-21/530
BRANCH 44737
1-1G
WACHOVIA
Wachovia Bank, N.A.
w/acchoviia..com
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