45735_HILL, ANN_20060612 (2)

J.
Y-)(A .�.
❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous per it
❑New\I,Pfflodif,catio ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by Aa, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
e�< s'
❑ Rules attached.
Applicant Name ° ! Project Location: County
Address } .l Street Address/ State Road/ Lot #(s)
City /`'l /,C State ZIP ~
r� t
Phone # (r? ��i�� ` 4xFax # �)
Authorized Agent
Affected ❑ CW ❑ EW -Q-PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Subdivision
City
ZIP
Phone # ( ) River Basin t, +" .�"•.
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
f I', I; r 14 1- 4•-' I k I J i ,IUIN L t. LUUU I );
Agent or Applicant Printed NAme r Permit Officer's Signatu ,-
it
� t; J
Signature Please read compliance statement o rm� i a pirati n Date '
Application Fee(s) Check # Local PlanningJurisdiction 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, 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 ;I 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 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: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

1
ADJACENT RIPARIAN PROPERTY OWNERS TETy 2006
(FOR A PIERIA100RING, PILINGSIB OA TLIFTIB OA THO USE)
Morehe d ity Xfo
I hereby certify that I own property adjacent to(N ame of Property Owner)
—)�'
located at
property -- (Lot, BI�-ze.)
g-tt
in , N.C.
on (To- n and/or County)
(� erbody)
He has described to me, as shown belo�4', fobs devei Pil l. understand proposing
t pierJm oorthat ong
and, I have no objections to his prop
pilings/boadifftoathouse must be set back a minimum distance of fifteen feet (IS') from my area
of riparian access unless waived by me. u..
I (10 Il I wish to waive the setback- requirei»ent.
I S1i� ��'ish to N\•aive that setback requirement:
17
DESC tr>-r10N AND/OR DRANYING OF PROPOSED DEVELOPNIENT:
(To be filled in.by iu(lii•idual proposing rle►elop,nen!)
95�11�
------------------
�ignaturz Q �
/- 1�
Print or Type Name
Telephone Number
t )MO< q - Z0 —04

H wy /4
DR E: HE:- ^-u, c i
//Xj 30&�ff SoL.4,-Jf) /�
.? j 6
Ce Ale ( it
F-foTit-)&-
b Ecr,

w
OPERTY O�VNER STAT
ADJACENT RYPARIAN PR TI OUSE)'
A PIER/MOORING, PILINGSIBOATLIFT/130A �w fI,4�
(FOR '�/ C t.? r11
/ oo
I hereby certify that I own property adjacent to(Name of Property Owner)
property located at 1etc.)
(Lot, f3 k, Ro ,
G��� N.C.
in
on
(ti; J :;erbodyl, (To vn and/or County
-r�nocina at that location,
He has described to me, as shown belo\v, the deveiupultnt N �-r�--
ro proposal. I understand that a pier/mooring
and, I have no objections to his p p
pilings/boatlifYboathouse must beset back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by n}e• u:.
1 Slll 1} %vISh to %valve the setback requirei}}enl.
1 Slip %�-Ish to waive that setback requirement.
------------------------------
DESCp\IP TION ANDMIZ I)RANYING OF PROI'OS'ED DEVELOP�"I.
(To be filler! in h_> inrliritlun! proposing rlel•elopment)
I Mijc
Oftk
_____________________
------ 44 - ------------------------
signature
print or T} pe
�---7
'Celepllone Number ,/

.glj 4
Ccni � f
c [AA-VUE -S A tit-) L—
Hw,/
PA C) I? F c I y
a—..
4N
C