45101_GILLIKIN, AL CARL_20060330

ElCAMA / ❑ DREDGE & FILL �� l
GENE L PERMIT Previous permit#
❑.New kkModification ❑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
vERules attached.
Applicant Name t ti i` 1_ f f, r I i! n r Project Location: County
Address i `� '- 1 j 1'-4 •: � � `�f �' Street Address/ State Road/ Lot #(s)
City1= t i. Y �� i�', !; State ZIP a
Phone # S
Fax # Subdivision
O : O 1
Authorized Agent City ZIP
Affected ❑ CW 0 EW EIRTA [IES ❑ PTS Phone # ( ) River Basin
() ❑ OEA ElHHF ❑ IH ❑ UBA ❑ N/A
AEC s : Adj. Wtr. Body (nat /man /unkn)
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity 7,:�Dj� c, T7Q
(Scale: )
Pier (dock) length
Platform(s)
Finger pier(s) it
Groin length L
numbers — — - — — ---- — ---- ---- -- --
Bulkhead/ Riprap length
avg distance offshore
max distance offshore �- [ �� iMA
Basin, channelC���UC �c
cubic yards 11Boat ramp -
Boathouse/ Boatlift J
Beach Bulldozing —
Other 4 1
- _
it J
L
r 1
i Shoreline Length
fr ,.
SAM not sure yes no --
Sandbags: not sure yes no 1
I
Moratorium: n/a yes no
Photos: yes no I LWaiver Attached: yes no
A building permit may be required by: ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name APR 4 Permit Officer's Signature
2006
,, 1•.. j
Yi
1
Signature **Please read compliance statement MC suing ate �(' ' Expiration Date
Application Fee(s) Check # 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
landowners).
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 E 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/ 1-888ARCOAST
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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

MAR-22-2006 11:07 PM P.01
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1 hereby Certify that l awn property al A"
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property located at
(street Address. Lot, Stock, ROTA eft.)
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�p [ S -- .�.. -� in (Town and/or CO USt7'i
ty�rsterbodY} at that
the develVmmi hdahe is pTOp°S
geisha his described to ene, as shown balaw, l undtrstaald that a pierlmd►6
lac.gion and I have m objactinns to PQO1'0 of fifietnfeet {I5') froth My a of
piiiogslbaccess unless oatlifpe�°` must be set back minimum d �taana by littg below;
riper waived by mt. 1 havea indicaocd my
1 4aW agree to Wlive the 15' setbed requirement.
(inicWtj
I seta to wRivt the 15' setback N►tsmcnt- .- ------ __---
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DESC,WT10K AND/OR D �d lldr�al ArapaOirtWNG OF 't d DEVELOPMENT;
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MAR-22-2006 11:08 PM
P.03
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIE&MOORING PILINGS/BOATLIFTIBOATHOUSE)
l hereby certify that l own property adjacent to +�
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(Name of Property Owner) 0.16
property located at
(Street Address, Lot, Block, Road, etc.) �
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on ��-c,lC,, S �.L� , in JRv �e-� ��' ,
�. � ��1. Al.� rn
(Town and/or County)
(Waterbody)
He/she has described to me, as shown below, the development he/she is proposing at that 0-
location and I have no objections to this proposal. I understand that a pier/mooring
pilings/boatliftlboathouse must be set back a minimum distance of fifteen feet (15') from my area of
riparian access unless waived by me. I have indicated my intentions by initialing below:
I do not agree to waive the 15' setback requirement.
(initials) +
I do agree to waive the 15' setback requirement.
(initials)
y . DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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------------ - -- - - ------------------ - -------------------- - --
------------------------------- ---
Signature
Print or Typi Name
Telephone Number
Date:

ALGERNON C. OR RHODA G. GILLIKIN
NCDL 6303024 DOB 8-16-67
Ph Box 538, 63 ) (— (.
P O Box 538, 632 Island Road —1 'j (p
Harkers Island, NC 28531 Dace
IN WACH0VIA/)5 AV l ci
Wachovia Bank, N.A.
wachovia.com
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