43174_FORREST, TERRY & PAT_20051010

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GENERAL PERMIT ~------+ I •
ous permit #
New [!)Modification E- Complete Reissue CPartial 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
ules attached.
Applicant Name `—!F l y c - ��`G�� Project Location: County �' AZ ' � ?4- i
Address f2-_5'0, �a �� Street Address/ State Road/ Lot #(s) Lz--l%-
City p lfr5 bo ra Stated ZIP' ,
Phone fl l y Z3 Fax #? ,-'1 ? Subdivision
Authorized Agent City ,� 41 el Q f /� %5 � _ ZIP
Affected Cw ViW ekA �S ❑ PTS Phone # (..� 5� ) 75 �� %�� �'"7 River Basin f,///iT� 69,4W
OEA HHF IH UBA N/A i"
AEC(s): 1 El Adj. Wtr. Body �St�l-' �(� /man /unkn)
PWS: ❑FC: -
ORW: yes / no PNA yes rIG) Crit. Hab. yes / no Closest Maj. Wtr. Body f p ^
Type of Project/ Activity
' 1
Y�s'�r, �i✓ 2 Drc �C ,_%'4 -' F�. 7i� �c 4/ (Scale:
Pier (dock) length
Platform(s) �. <-r �•�'r�'
Finger pier(s)
Groin length
number - - - -
Bulkhead/ Riprap length + t�
avg distance offshore C
max distance offshore_ .
Basin, channelQ\
cubic yards _
Boat ramp rrtc ',G ?fit l i f
Boathous�yoatliiIrr - - — --
'
A
Beach Bulldozing`_,
Other RRl i IQd� .'✓ f T"it: 3At- [4 S p�
rev
Shoreline Length
SAM not sure yes
Sandbags: not sure yes n`
Moratorium: n/a yes
Photos: yes no rllr ►k7�y� �U r}
Waiver Attached: yes ---.--..--- —--\\\----��/� �-p,y IL
A building permit may be required by: �/') 0 1 11 L D �s � ��`�' � See note on back regarding River Basin rules.
Notes/ Special Conditions{,� �' 1/) �c T 7k a v!o Tn rp4 r- 4, �f� ` .�/ i y +r 17
�� pp� l / r 1, J/'
(�* %[/A 7� 1 f f / "' f C �C r 4 L-y 9/� ! �O fn ink' �li! Af t�
wi
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check •#
Permit Officer's Slignature Praq 10er4-14i7', Q
i t r I I c� CAS 1361""o , 11i I o
Issuing Date} Expiration Dite
Y 1610 k l `( A
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 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 ❑ Other:
0 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
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

10/18/2005 14:26 FAX [phone] WAYNESBOROUGH OP
00-10-2006 U 08,56 AN MC D I V OF Mlb7AL MGW FAX Wa 4 1
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10/18/2005 14:26 FAX [phone] V�'AYNESBOROUGH OP
WAYNESBOROUGH OPHTHALMOLOGY, P.A.
EYE M.D.s
103 COX BOULEVARD 0 GOLOSSORO, NC 27534
[phone] • 1-800-442-6346 • FAX [phone]
WAYNESOPHIPSELLSOUTH.NET
FAX
TO: o �� �� l t�✓
FAX NUMBER:
FROM:
�s
DATE: NUMBER OF PAGES:
(including cover pages)
If there are any problems regarding this transir issior
please call: [phone] or fax: [phone]
REMARKS:
BARRY H, TEASLEY. M.D.
TERRY L. FORREST. M.D.
MIGMAEL R. WILLMAN, D.O.
ROBERT G- HARDING. O.D.
This facsimile may contain privileged and confidential information intended only for th use of the
inditiidual or entity to which it is addressed. if Lhe rcadcr of the facsimile is not the inic nded recipient or
the employee or agent responsible for delivering it to the intended recipient. you are hemby notified that
any dissemination, distribution or copying of this communication is strictly prohibited. you have received
Iris facsimile in error, please immediately notify its, by telephone and return the origi facsimile to the
above address pia the Postal Service. Thank vou.

10/06/2005 15:05 FAX [phone] WAYNESBOROUGH OP
WAYNESBOROUGH OPHTHALMOLOGY, P.A.
EYE M.D.S
103 COX BOULEVARD a GOLDS6ORO, NC 27534
[phone] 9 1-800-442.6346 0 FAX [phone]
WAYNES0PH@BELL50UTH. NE-r
FAX
TO:
FAX NC.7M13ER:
FROM:
`3 `3 -3 r;
DATE_ io - U S NUMBER OF PAGES:_
(including cover pages)
If there are any problems regarding this transmission,
please call: [phone] or fax: [phone]
REMARKS:
Z01
BARRY H_ TEASLEY, M.D.
TERRY L. FORREST, M.D.
MICHAEL R. WILLMAN, D.O.
ROBERT G. HAROfNG, O.D.
Tltis facsimile inay contain privileged and confidential information intended only for the use of the
individual or entity to which it is addressed_ If the reader of the facsimile is not the intended recipient or
the employee or agent responsible for delivering it to the intended recipient, you arc hey notified that
any dissemination, distribution or copying of this communication is strictly prohibited If you have received
this facsimile in crmr, please inunediatcly notify us by telephonic and return the original facsimile to the
above address via the Postal Service. Thank you.

10/06/2005 15:05 FAX [phone]
WAYNESBOROUGH OP
002
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10/06/2005 15:05 FAX [phone] WAYNESBOROUGH OP Z 03
i3/05/2005 15.56 2523542355 EMERALD ISLE REALTY PAGE 02/02
►1-464 FAA VLV!446J6? WAYNESBOROUM OP
SAC W 3MAMAN PROPERTY CK"UR STATEMENT
I busby certifj► that I own prep" adjac= to
fi h 's
prope" �ocsama ar �5 i 5e�.�c etproperq► o�.�r)
CC (� Addr�, i� � Road. eta.)
on t,+.� c�0 Gum in fi�¢�Q LS� Nc
(9Vntierbvdy) {Te" atWvr Codwty)
EWSIM has deg *W to mq as sb"m below, ft dcvcbpumw b W he ee pmpamM at that
locadon *Ad I have no objeadow to thus propoaj1
DESCRaTr N A" �TD/OR DRAWLNG DF MPOM A»•r"j MEXT
(To bd~imb! AmefigWomo
(SW a#akx4-)
Pant or Type None / t
r r

.10/06/2005 15:05 FAX [phone] WAYNESBOROUGH OP Z04
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to!�}` (("/�P-1'f 's
(Name of Property Owner)
Property located at 7 i Seundlrl of —
(Street Address, Lot, Block,Road, etc.)
on UQ auvtd in Lb4. asd 45(a _ N.C.
( terbody) (Town and/or County)
He/she has described to me, as shown below, the development he/she is proposing at that
location and I have no objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be jflled in by individcal ProPosinB devetaPment)
(61U_
k-(�� &J4ed)
Signature
P-� L06) 0(&)
Print or Type Name
`�\R-`?S4_- I _Re)
Telephone Number
Date: L 0 C-5

Detailed view for record 1 (Print)
F —ie I d--1 I Value
AREA 20184.26414
PERIMETER 717.59266
PARCEL83_ 50285
PARC E L83_I 50316
WHAT 0
PIN
MAPNUM 5394
BLOCK 21
PDOT 3168
CONDO_
MOTHER 0
MAPNAM 539417
PRID 15034D1913
PIN15 539417213168000
OWNER FORREST,TERRY L ETUX
PATRICIA
DBOOK 0668
DPAGE:= 100218
DDATE 0
SALE_PRICE 0
TAX_VALUE 555700
LAN D_VALU E 197340
STRUC_VAL 332284
OTHER_VAL 26076
BLT_CONDO 0
HOUSE_NUM 0007518
Fiek�` Value
DIRECTION
ST NAME JISOUND
ST TYPE DR
CITYJIEMERALD ISLE
ZIP 28594
MAIL_HOUSE 2503
MAIL DIR
MAIL ST ISAAC DR
MAIL_STTYP
MAIL -CITY GOLDSBORO
MAIL STATE JINC
MAIL ZIP 27530
MAIL POBOX
TOWNSHIP WHITE OAK
CITY_LIMIT EMERALD ISLE
NBHD 560043
FIRE DIST
RESCUE DST
LEGAL DSC L6 P1 MARITIME FOREST
TOTAL ACR 0.499
Y BLT HOUS 111993
TOT SO FT 12798
BATHROOMS 715
BEDROOMS 4

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Field Value
AREA 20184.26414
PERIMETER 717.59266
PARCEL83_ 50285
PARCEL83_I 50316
WHAT 0
PIN
MAPNUM 5394
BLOCK 21
PDOT 3168
CONDO_
MOTHER 0
MAPNAM 539417
PRID 15034D1913
PIN15 539417213168000
OWNER FORREST,TERRY L ETUX
PATRICIA
DBOOK 6668
DPAGE 60218
DDATE 0
SALE_PRICE 0
TAX VALUE 555700
_I I�AN� n v 119734n II
1
Fiel
J Value
DIRECTION
ST NAME I
SOUND
ST TYPE JJDR
CITY
1EMERALD ISLE
ZIP 1128594
MAIL_HOUSE
2503
MA1L_DIR
MAIL ST JJISAAC
DR
MAIL STTYP
MAIL CITY=IGOLDSBORO
MAIL_STATE
NC
MAIL ZIP
27530
MAIL POBOX
TOWNSHIP 11WHITE
OAK
CITY LIMIT
EMERALD ISLE
NBHO
560043
FIRE DIST
RESCUE DST
LEGAL DSC
L6 P1 MARITIME FOREST
TOTAL_ACR
0.499
Y BLT HOUS
1993