42733_MAINES, GAYLORD_20050818

Z] dAIVIA / F-1 DREDGE & FILL
GENERAL PERMIT Previous permit #
nNew F—Modification ElComplete Reissue LIPartial 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 NCfC
El Rules attached.
Applicant Name 6-,4YIolol j4lalAle5 Project Location: County
Address �i' O— Street Address/ State Road/ Lot #(s)
City 5- 7'
State AIC ZIP 75Z) 3
'AW) 'V 99 Fax # Phone # ( Subdivision
Authorized Agent city 4e' ,Ietlel ZIP 7 7
Affected I -- CW R EW 4RI-ITA DES D PTS Phone # 94T:2- River Basin It
F-1 OEA D HHF El lH El UBA Ll N/A // 91 ', - /', 1.�
AEC (s): -1 ' PWS: EIFC: Adj. Wtr. Body --7, lile— , , 6nDman /unkn
IV
ORW: yes / no PNA yes / no Crit. Hab. yes no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s) x .6�
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
maxdistance offshore
Basin, channel
cubic yards
Boat ramp
Boathousqrgoatl*2
Beach Bulldozing
Other
Shoreline Length
SAV. not sure
yes
Sandbags: not sure
yes
r
Moratorium: n/a
yes
Photos:
yes
n)
Waiver Attached:
yes
no
A building permit may be required by:
Notes/ Special Conditions
>
-1
Agent or Applicant Printed Name
Signature Please read'com'pliance statement on back of permit
Application Fee(s) Check #
7V
L
El See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local Planning jurisdiction Rover File Name
L
El See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local Planning jurisdiction 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 [)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
[] Neuse River Basin Buffer Rules
j Other:
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

HOLD DOCUMENT UP TO THE U IIIIIM .VIEW TRUE -_DOCUMENT"v v E V v WATERMARK J � .r t HOLD UP TO THE LIGHT TO VIEW TRUE WATERMARK
1-97
1020 424474879
1028100
WACHOVIA
Pay To The C.A.M.A.
Order Of
N
CJ
" ONE HUNDRED DOLLARS AND 00 CENTS
08/17/2005
$ $100.00
Dollars
DRA ER: Wachovia Bank, National Association
ALTON JOYNER O (� `l1 Illl .1-� �_ mom«
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MIR
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Remitter Au rized Signature
Issued by Integrated Payment Systems Inc., Fnglewood, Colorado
NA CSenver Colprado
lie 3S092711' 1:L020009791: 58004241,?La 79Sill
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ADJACENT RIPARLAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PfLINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to �f� LL% % �/ .� 's
(Name of Property Owner)
property located at /5� �� i SR
(T10t, Block, Road etc.)
on Al in ' �� �� N.C.
(Waterbody) (Town and/or Cou ty)
He has described to me, as shown below, the development he is proposin7 a: tat location,
and, I have no objections to his proposal_ I understand that a pier/mooring
pdings/boadift/boathouse must be se: back a minimum distance of fifteen feet (15) from my area
of riparian access unless waived by me.
.: I do not wish to ware the setback requirement.
I dr wish to waive ti7at setback recuirement_
DESCRIPTION AND/OR DRAWr G OF PROPOSED DEVELMIE`T:
(To be filled in by individual proposing development)
�S' ature
Print or Type Name
` '40 � �' -- -V 7
Telephone Number

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