42402_LEWIS, PERRY_20050721

17-2� -65"-Cob
f ICAMA / fJ DREDGE & FILL
GENERAL PERMIT
INew Modification ❑Complete Reissue Partial Reissue
•
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
rk 1)
Previous permit #_
Date previous permit i
ached.
Applicant Name p / ` ` LQ�­ f Project Location: County" "
Address t� �` % �., % �� ) ,{'
Street Address/ State_ Road/ Lot #(s)
�j y
City it v E ' State ;V t zip - -
2
Phone # ( ) �' - ~:?o V 1�ax # ( ) Subdivision
Authorized Agent City �F '�% ' zip
Affected -Cw El ©-PTA 0•ES ElPTS Phone # ( ) _ River Basin IV (-" s—'t
ElOEA ❑ HHF [IIH ElUBA El N/A ,�-
AEC(s): Adj. Wtr. Body (nat yman /unkn)
❑ PWS: ❑ FC: Y
ORW: yes / no PNA yes./ no Crit. Hab. yes / no Closest Maj. Wtr. Body ---
Type of Project/ Activity
(Scale: IV � )
Pier (dock) length b _
Platform(s) X `
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 /
SAV: not sure yes no
Sandbags: not sure yes ('no.
Moratorium: n/a yes -' o
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Aj plicant Printed Name
Signature, *XPleaseF ad compliance statement on back of permit"
-4i U ?
Application Fee(s) Check #
—' See note on back regarding River Basin rules.
f L' J
Issuing Date Expiration Date
M
Local Planningf urisdiction
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, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar -Pamlico River Basin Buffer Rules I 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 howto complywith 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 / 1-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B 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

JUN-27=2005 MON 04:40 PM NC DIV OF COASTAL MGMNT FAX NO, 4 P. Ol
AJ)JACE NT RIPARIAltil ]['Ta.oprRTY O i � R S1'ATE',MEN'i,
(1,*0R A PIERIA100RING PIS.INGSIBOATLIFTIROATHOUSE)
I }Zereby certify that I own property adjacent to _ �T"er� f� ��; w�-__'s
(t�'anre oPs operty Owner)
prc� x_;t t lcxntod at^��� : -----
(I.ot, Black, .bond, etc.)
cart _ 3��Je, _. A��� __, in CA4 r + ���.�.� , N.C.
(Waterhody) (Town and/or County) ,
II4� h3S f1�:SCrlbccl to Tne, as shown below, tlic development he is proposing at that tocation,
ancl, I havLt nu objections to his proposal. I understand that a pier/mooring
piling,s1't�i�atfiftlt�oaii�ouse must be sttt beck a minimum distasice of fifteen feet 1S' from �n nrca
Of riparian ,access watvcd by mc.Wri 70—
I ch.)l)A wish to waive the setback requirement.
JUL 0 6 2005
I do wish to waive that setback requirement.
---- Morehead City DCM
ANWOR DRAWING OF PROPOSED DEVELOPINIENT:
(To b� filled in by individual p1-oposirig development)
prl,0•lclubA.¢ CAKMI
rya
'P,
Q� ,F-- i � =-� �- t' °�` --ems �- � • d ` � r t • a'�s
�bX
Q-----------------------------------
Signature
yrint or'rype Name
,�2,
' e cphone Number
Date;

JUN-27=2005 MON 04:40 PM NO DIV OF COASTAL MGMNT FAX NO. 4 P. 01
AJ)JA(-' :NT RIPARIAN PROPERTY OWNER STATEMENT
(POR ,A PIL'ii/iVt00R1tVG PILINGSIIIO�ATL.IF2"IROATIIOUSE)
I hereby certify that I own property adj,aceof to S
(Name of Property Owrlcr)
l�rc�l�c.;t ty lcxatci! at _.. �'� 7` ,. -7•/-i� 7-Z
flock, Road, etc.)
On in , N.C.
�' -�
{;tfler h�giy) (Town and/or County) ,
III, }las c!,�,scribed to me, as shown below, the development he is proposing at that Location,
end, I have no ot}jeLlians to his proposal. I understand that a pier/mooring
pillntyc!boatl�Et/},)L7tilollse must be srft back a niinimurn distance of fifteen feet (15') from Orly nrca
0[ riparian ,`1c cutss Dilless waives[ by 1110.
yi. wish to %yaivc the seback requirement.
f
BI
I c_o wis}l to waive that sctback requirenicnt, ,JUL 0 b 2005
------------- ------------------------------------
I) LI''I'ION ANAWOR DIuMING OF PROPOSED DLVI10WhWd OtY I-)C;M
To be filled in by individual prvposing d"ClOpmenr)
------------------
Print or'1 ype N
Telephone Number
Date:

C c'oSs
3014
8 )C I-ren}eA 1DDub1ed"
C u; TreA}ej

PERRY L. LEWIS 2367
TANYA LEWIS
319 BALL FARM RD. 252-447-3006
NEWPORT, NC 28570-6125
T& /IBCI
de�am�f-ol
BBBT
BRANCH BANIUNG AND TRUST COMPANY C i a o e c
VELOCK, N TH CAROLINA
4053LOIL2W:i203022626►i'023E,
66-112/531
02001