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❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Previous permit #
❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resourc
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA N C
Applicant Name Project Lo tion: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O Fax # O
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
AEC(s):
❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) len
Platform(s)_
Finger pier(s)_
Groin length
number
Bulkhead/ Ripr
avg distar
max distz
Basin, channel
cubic yar
Boat ramp _
Boathouse/ Bc
Beach Bulldozi
Other
Shoreline Leng
SAM no
Sandbags: no
Moratorium:
Photos:
Waiver Attach,
A building permit may be required by:
Notes/ Special Conditions
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit. Hab. yes / no
❑ Ru
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: )
❑ See note on back regarding River Basin rules.
DEC - 4 2006
Agent or Applicant Printed Name (� Permit Officer's Signature
hill—riphinnel
Signature "Please read compliance statement on bac r t "' it sswgWAI I Expiration Date
Application Fee(s)
Check #
Local Planningf urisdiction
Rover File Name
V
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 ❑ 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:919-733-1495
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:252-264-3723
(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: 252-247-3330
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mali
Washington, INC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05
4 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to CiuR.N A 's
(Name of Property Owner or Applicant)
Mailing address if different from location address 1 006 L �w1ti e
(town, state and zip) �c►.r �O
Cr
J
phone numbers you can be reached at Z.S 4 91 i� NOV 3 0 2006 ,
property located at L.-}- a`1 Sov�,�.s�,�, o�i< , V\11 �11�`{ cfreheeel r,:� ..CM
(Lot, Block, Road, etc.)
onGNA1 41 o4. "T—c w , in Cc'rA- Co.
(Waterbody) (Town and/or County)
N.C.
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me.
initials
initials
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
-----------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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EX.si.'IN Saoee--.1`T
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----------------------------------
Signature
Print or Type Name
Telephone Number
Date:
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to ►.Jo.,,. 1-uR Na4 's
(Name of Property Owner or IEMailing address if different from location address 1606 L �,r ov e-�-
(town, state and zip) �tU,e G �-� S NOV 3 0 2000,
phone numbers you can be reached at ZSJ— :)LtA0 _ 4 9 re MQrshearl
CM
property located at Lo-i-
(Lot, Block, Road, etc.)
on CpNAk A of -I_ c W , in C ev'k—1 , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me.
Nt I do not wish to waive the setback requirement.
bats
I do wish to waive that setback requirement.
initials
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------
Cbrai3C
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------------------------- -------------------- --------Y -------------
nature
Print or Type Name
Telephone Number
Ir
Aug 30 06 01:48p Coastal Equipment Rental 2527268340 p.2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFT/BOATHOUSE)
s I hereby certify that I own property adjacent to Z-,J f vjktj C 's
(Name of Property Owner or Applica
Mailing address if different from location address 1006 L "'rA f�
� jjt$S3
t-1,
7=
(town, state and zip) (� ��� C-
0 2006
phone cumbers you can be reached at �.� �— ��0 � �
property located at i,�t X� -550 „t— pF�'t� [AW4Morehead City DCM
(Lot, Block, Road, etc.)
on C.,on A o4 -T-- c L J Ce"e k"V C e" A.—, N.C.
(Waterbotty) (Town and/or County)
Ile has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal, I understand that a pier/mooring pilings/boathft/boathouse
must be set back a minimum distance of fifteen feet (15D from my area of riparian access unless
waived by me.
V� I do not wish to waive the setback requirement.
ini6a6
I do wish to waive that setback requirement.
:nivals
DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
of
L
T
signature
r �
Print or Type Name
Io
Telephone Number
Date:
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DAVID A. FURNA ,"'i': N% 1010
1006 LINDA CT.1 f�r`.��r�;
NEWPORT, NC 2a570j`N %`�,��. `�% % %� I !��,
252-247 4811J Date I (�� O �o ��� ..,66-30/53�
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