46728_HOLLAND, JOSEPH_20060929

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❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification El 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 I SA NCAC
Applicant Name_
Address-
City -
Phone # ()_
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
State ZIP
Fax # ()
❑ EW ❑ PTA
❑ HHF ❑ IH
❑ FC:
PNA yes / no
Type of Project/ Activity
Pier (dock) length _
Platforms)
Finger piers)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes
no
Sandbags: not sure yes
no
Moratorium: n/a yes
no
Photos: yes
no
Waiver Attached: yes
no
A building permit may be required
by:
Notes/ Special Conditions
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit. Hab. yes / no
Previous permit #
Date previous permit issued
Rules
Project Location: County
Street Address/ State Road/ Lot #(s)
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.
I l i F ZUU6
Agent or Applicant Printed Name Permit Officer's Signature "head Cib Z�
DGAA
Signature,., "Please read compliance statement on back of permit" Issuing Date Expiration Date
Application Fee(s) Check # Local Planningf urisdiction 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, certifythat this project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
[� Tar - Pamlico River Basin Buffer Rules
LJ Neuse River Basin Buffer Rules
❑ Other:
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:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
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,
Orslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

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Postage
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Certified Fee
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RetReturnPosReceipt Fee
(Endorsement Required)
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Restricted Delivery Fee
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(Endorsement Required)
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[` - --- - ---------------------------------
Street, Apt. No.: """"----"----""
or PO Box No.
City, State, ZIP+4
io0, June 20C
■ Complete items 1, 2, and 3. Also complete
itam 4 if'Restricted Delivery, is desired.
■ Dent your name and address on the reverse
si that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
jef Sdvvateter
(�Cl �sL,IrGeT Lclov�
A. Signature
;? Agent
U4 t,r �� ❑ Addressee
B. ceived by (Printed Name) C. Date of Delivery
oAN�Majq't-C-"� 9-12-01,
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ce Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7006 0100 0005 0045 7948
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
~ DIVISION OF COASTAL MANAGEMENT
• ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER
FORM
Name of individual applying for the permit:
Address of property: My I/
6-1,��i (Lot or street#, street of road)
Mailing address: og/4 - )!-'�3aj/> &
I (City & County) {yM©rohOdd City/ oc;M
Phone number you can be reached at � -(.4,
I hereby certify the I own property adjacent to the above referenced property. The
Individual applying for this permit has described to me (as shown on the attached drawing)
the development they are proposing. A description or drawing, with dimensions, should be
provided whit this letter.
DI have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, 400 Commerce Ave., Morehead City, NC 28557 or call [phone] within
10 days of receipt of the notice. No response is considered the same as no objection if you
have been notified by Certified Mail.
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or sandbags
must be set back a minimum distance of 15' From my area of riprap access unless waived
by me. (If you wish to waive the setback, you must initial the appropriate blank below.)
/1"do wish to waive the 15' setback requirement
I do not wish to waive the 1,5/, setback requirements
SigDate
,/E)F�Z� �3 S Gh � �� c'tetz
Print Name
7
Telephone number with area code
www.nccoastalmanagement.net/Permits/RiparianSetbackWaiver.pdf

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
' (FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHO
I hereby certify that I own property adjacent to
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(Name of Property Owner or Applicanf� l� '- W'
Mailing address if different from location address 130/ ,
(town, state and zip) -7 5 AA
phone numbers you can be reached at� 7 �1
property located at `OCR
on in Ne�i�C7 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.
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)
00- ; d Fu K ti
Print or Type Name
`` V b' ► H, r �
-e-9,P-er
Telephone Number
Date: 1"S- 6�

3527
JOSEPH H. HOLLAND NCDL 5445985 66-593/531
JANIE M. HOLLAND NCDL 3214629
PH M-284-4902 D
9442 HOLLAND RD DATE
KENLY, NC 27542
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PAYTOTHE 2 J $�
ORDER OF ( \
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