40960_GRIFFIN, JONATHAN_20050210 (2)

AMA / DREDGE & FILL N? 40960
�*NERAL PERMIT Previous permit#
ew FlModification . 1Complete Reissue F-Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources / Ci
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / Z �, _
UIRGles attached.
Applicant Name LJ�%nA-� �.<%/^ ')0e'--" Project Location: County CAA e mot
Address ! Q't/` / `[ Ad
/ Street Address/ State Road/ Lot #(s)
City ' Ari r^AState1VC ZIP
i
Phone #�Y Fax # ( ) Subdivision j
Authorized Agent City e (*l--!r/i �%� ZIP
Affected XW elj�l'lftA ❑ PTS Phone # (?A) rf z—2.10y River Basin e�✓ 44rk— G/!
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body D --yd ElPWS: ❑ FC: J� o G' 1 �a /man /unkn)
ORW: (yes no PNA yes n'o Crit. Hab. yes / no Closest Maj. Wtr. Body j -�t'c w n�
Type of Project/ Activity
Pier (dock) length /fs
Platform(s) ��tX
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards i
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
V �
56"Cl
t
1
i I
(Scale:
A� -
!i
—7 , � `
Shoreline Length S \
SAV. not sure yes n6
1
Sandbags: not sure yes n 7r CL
Moratorium: n/a yes j } ,
Photos: yes 2, I k
Waiver Attached: yes no //r r '/
A building permit may be required by: �j'�`�/' ✓" e See note on back regarding River Basin rules.
Notes/ Special Conditions 2 SI i a(' or Z{'J l) / 41`,-
)7-
Agent or pli nt Print e^ame
S' nature PI compliance statement on back of permit"
Application Fee(s) Check #
Permit O s Sig20's-
ture
/I�
IssuingDate
Expiration Date
�aU� �021o1yA
Local Planning Jurisdiction Rover File Name

- , s
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, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
1__ 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 (910-395-3900) for more information on how to comply with thesebuffer 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 / 1-888-4RCOAST
Fax:[phone]
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-13 Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
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
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

APPENDIX K: Telephone Referral Form
DCM Telephone Referral Form
Date
DCM Staff (initials)
Name of Caller (if needed)
Area Called From V
Address(if needed for followup)
Phone NO
Nature of Question or Request
P� �N\" A
Referral Made to Caller ✓"es No
Referral Made to: DEM/FENIA DC�I Field Office: l�
Small Business Admin. Local Utility Red Cross
Other (Please note)
Other General Information Provided to Caller
Followup Needed'? ✓ye, No
Followup Assigned to:
Appendix K
E