43660_GASNON, PHIL_20060119

State, `, <
ZIP
Phone # O zv`
i %'t
Fax # O
Authorized Agent
- CW
❑ EW
❑ PTA EkES
❑ PTS
Affected
rj OEA
AEC(s):
❑ HHF
❑ IH 0 USA
❑ N/A
PWS:
❑ FC:
ORW: yes / no
PNA
yes / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)_
Groin length
number
Bulkhead/ Riprap length____
avg distance offshore_____
max distance offshore
Basin, channel
Boat ramp t
CAMA / -'' DREDGE & FILL
GENERAL PERMIT
I_INew Modification [-]Complete Reissue ❑Partial Reissue
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
Pre tious permit #
Date previous permit issue
Rul
Applicant Name "� t f 1` J%' Project Location: C3unty_
Address r /�, Street Address/ State Road/ Lot #(s)
Subdivision
City�` ... ZIP
Phone # (-__) River Basin
Adj. Wtr. Body_ l =y ' gnat /man unkn)
Closest Maj. Wtr. Body
(Scale: t / i )
- t i
_- __ -- mow• .. , . _ i r ..r• �-.
Boathouse/ Boatlift
Beach Bulldozing
Shoreline Length
SAM not sure yes o) -
Sandbags: not sure yes o
Moratorium: n/a yes
Photos: yes nd
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
t
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Da a xpiration Date
Local Planningjurisdiction Rover File Name

Y
16
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:[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/ 1-888-4RCOAST
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

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
A. Signature
❑ Agent
X /mac L-� - ❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
5; San Azee4<, ,e 112Z-Vos-
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ice Type
ertified Mail El Express Mail
FiRegistered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7004 1350 0003 4219 5024
(Transfer from service label)
PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
'2X -
jE
. _ _ _ i!!I!III1�lilli!Il�lt!1!Fllllifli i!!1!It!iE!!i�l!!lEil3!!t!jIl

ADJACENT RIPARIAN PROPERTY OWNER STATENLENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at l`i' (c E/n E q L 7 PR
(Lot, Block, Road, etc.)
on &C—OE ! cO , in FmekfiL1T) 154f C'/}/;71_Rk l Cry, 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be felled in by individual proposing development)
z
,nlEr� F�rSr�ti�
a R JR PRO PF rY
Sip6ture
r—a
Print Type Name
Telephone um r
Date: / �r s 6

• ADJACENT RIPARIAN PROPERTY OWNER STATENIFNT
I hereby certify that I own property adjacent to \Itlg y Pti a 6�lvdIU
(Name of Property Owner)
property located at
6 0 & Elm ERA- L 1) _DR, E/K ER)q L D / /V C
(Lot, Block, Road, etc.)
on 606-UE- S01,,/UD in Cm4AA1-P1S4,c! 6'- �Ax 7-FA E T- 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
Alcd ---
BLJLK#, A�-)
7-
GO
-T-Y Plqo Pf yq
0
N
Signature
Print or Type Name
c., ":xcicl qycl'�
Telephone Number
Date: 1i2-- G-

YVON, PHIL GL G N
FrH 354-5989
606 EMERALD DR
EMERALD ISLE, NC 28594
Pay to the �.
Order of C / G
Date
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State Em Io
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62 M°^ehe� Ci
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