43467_MOSS, BILL_20051019

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GENERAL PERMIT PreviouspPermit# f/
—.New `-jModification -]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 15A NCAC
❑ Rules attached.
Applicant Name Project Location: County_
Address J IX., k/ b r <' F; r Street Address/ State Road/ Lot #(s)
7
City ''r f1 K .� i;;r°«. s. State ( ZIP %,., �, �" :1 ; z (y -
Phone # ( ) -7 - ' C57 Fax # ( ) Subdivision
Authorized Agent .�'7 r r'u �" �� ,-^ � / � � - P�%' City ZIP__ _
CW 5�EW N PTA ,®'ES ❑ PTS Phone # ( ) River Basin
Affected - OEA ❑ HHF ❑ IH [I USA ❑ N/A
AEC(s): Adj. Wtr. Body------- (nat rn-- unk
PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body-
1
Type of Project/ Activity
(Scale: )
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 -__ _
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: 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
/r•.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
See note on back regarding River Basin rules.
G
Permit Officer's Signature
Issuing Date
Expiration Date
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 F-1 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
Elizabeth City District
Washington District
Mailing Address:
1367 U.S. 17 South
943 Washington Square Mall
1638 Mail Service Center
Elizabeth City, NC 27909
Washington, NC 27889
Raleigh, NC 27699-1638
252-264-3901
252-946-6481
Location:
Fax: [phone]
Fax: [phone]
Parker -Lincoln Building
(Serves: Camden, Chowan, Currituck,
(Serves: Beaufort, Bertie, Hertford, Hyde,
2728 Capital Blvd.
Dare, Gates, Pasquotank and Perquimans
Tyrrell and Washington Counties)
Counties)
Raleigh, NC 27604
919-733-2293
Morehead City District
Wilmington District
Fax: [phone]
400 Commerce Ave
127 Cardinal Drive Ext.
Morehead City, NC 28557
Wilmington, NC 28405-3845
202-808-2808/ 1-888-4RCOAST
910-796-7215
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
(Serves: Brunswick, New Hanover,
New River Inlet- and Pamlico Counties)
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

MONROE JOHNSON CONSTRUCTION, INC. WACNOVIA BANK, NA 4554
P.O. BOX 62$ 66-21/530
MOREHEAD CITY, NC 28557
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PAY THE
ORDERER OF
DOLLARS 8
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