42760_MELLOR, JOHN_20050920

LICAMA —L] DREDGE & FILL
417-1
GENERAL PERMIT Previous permit #
`_New ElModification LIComplete Reissue ElPartiall 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
Applicant Name �� 11 ( . 0r, El Rules at I tached.
Project Location: County
Address Street Address/ State Road/ Lot #(s)
City Y� State ZIP
Phone # 6e)f­)J';)Fax #() Subdivision
Authorized Agent City zip
D
Affected ICW Ll IEW ®`PTA 0 ES F1 PTS Phone# River Basin
0 OEA 0 HHF EJ lH 0 UBA El N/A 0 �. X
AEC(s): Adj. Wtr. Body (na)Jman /unkn)
El PWS: DFC: lPi - �-
01RW: yes / no PNA yes / no..) Crit. Hab. yes no Closest Maj. Wtr. Body
Type of Project/ Activity
� -19;1. 1 t
Pier (dock) length
Platform(s)_ 'N J
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
(Scale.
Shoreline Length
SAM not sure yes n
Sandbags: not sure yes n
no,
Moratorium: ye
n1a s
J
e-
-T—
Photos: yes
8no
Waiver Attached: yes
1.9See
01
A building permit may be required by:
note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer Signature
Issuing Date Expiration Date
,f
Local Planningjurisdiction 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, 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 j_, Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environment) 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 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
Fax: [phone]
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/ 1-888-4RCOAST
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,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

ADJACENT RIPARIAN PROPERTY0�WNER STATEMENT
2-4 ?_ dji�5`
I hereby certify that I own property adjacent to
(\'ame of Property Owner)
propertylocated at
im�
(Lot, Bloch oad, eton
c.)
(Waterbod}') (Town end/or County)
He has described to me as shown belo,,�,, the development he, is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION ANTD/OR DR.A fNG Off' PPOPOSED DEN'ELOPAIENT
(To be filled in by individual pro using devela menl)
Signature
Print or Type Name
Telepho.-�e Number
Date:
Z ��
-29-
I�
1

ADJACENT RIPARIAN PROPER I �' 0��`I�'ER STATEMENT
T hereby certify that I own prop: rty adjacent to J
Q(
(\' a m e g� P�-V rt
pro pe r7• located at 1-21 C � L 44-_
(Lot, Bloc , Road, etc.
on _
(IvVaterbody) (Town and/or County)
He has described to me as shown. belo�N, the development he- is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AN`D/OR DRAIIJNG OF PROPOSED DENTLOPI-%1ENT
(To be filled in by individual propos' deve,gpmept)
01
X"
tit
Print o: Type rdame
,;) S 2- r "?,
Telepho,,-ie Number
--�� S
Date: 9-6 1/-
—29—

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