42704_KIRCHNER, CHERYL_20050830

C]CAMA / L DREDGE & FILL
I�
GPENERAL PERMIT Previous mit#
❑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 I SA NCAC
❑ Rules attached.
Applicant Name
Address
State _ ZIP
Phone # ( ) Fax # ( )
Authorized Agent _
Affected ❑ CW i , EW ❑ PTA
❑ OEA ❑ HHF =I IH
AEC(s):
❑ PWS: 1 FC:
ORW: yes / no PNA yes / no
I 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
v
Boathous oath]
Beach Bulldozing
Other
Shoreline Length
__;_.
I
SAM not sure yes
no 1
Sandbags: not sure yes
no
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
i
no --
A building permit may be required
by:
Notes/ Special Conditions
Agent or Applicant Printed Name
❑ ES ❑ PTS
UBA ❑ N/A
Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision_
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr, Body
(Scale: ' 11'� )
e i
°; "� ` '` ❑ See note on back regarding River Basin rules.
Signature ** Please read compliance statement on backof permit"
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name

r/
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:
n 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/ 1-888ARCOAST
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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

11
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at 1,9-> (( (14(1
01#CIY---
(Lot, Block, Road,etc.)on l�� (A) J\' , in 04NL I l "I , 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
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I dQ wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEVELOPMENT:
(To be filled in by indi�,idual proposing development)
'a-r ��,p I '5 —4 15
Si?nature
p s c , i3 L'
Print or Type Name
Telephone Number
Date: 1vn_S

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to T0kn+0VV-VI <'fc-6 e-(- 's
(Name of Property Owner)
property located at 13) l al '<() �lF i OC.
(Lot, Block, Road, etc.)
on (0J in A0VeL , N.C.
(Waterbody) (Town and/or Ci!!�ty)
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
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I d_Q wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by indi�-idual proposing development)
6FI8
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-------------------------------------------- ---------------------------------------------------------
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Print or Type Name
S'�- 2- 2(17-
Telephone Number
Date: /OS�

NOW -
John KirKirchner
ner
Cheryl
1811 Calico Drive
NC 285577 C(252) 7263655
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