45162_LAPSEN, GLEN_20060413

a4A aEDGE & FILL
GENERAL
PERMIT Previous permit # Iwc
LINew ElModification DComplete Reissue EJPartial 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 I SA NCAC
[I Rules attached.
Applicant Name Project Location: County_
Address— Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # Fax # O Subdivision
Authorized Agent City ZIP
Affected DCW r9EV aPTA [-I ES [:1 PTS Phone# River Basin
AEC(s): Ll OEA EI HHIF El lH El USA El N/A Adj. Wtr. Body f (nat /man_ /unkn)
D PWS: El FC:
ORW: yes / no PNA yes / no Crit. Halb. yes no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/K.a:tlift
Beach Bulldozing
Other
Shoreline Length
SAV. not sure 6Y.-- -)
no
Sandbags: not sure yes
'110
Moratorium: n/a yes
-, 'no
Photos: yes
Waiver Attached: yes
no
A building permit may be required by:
Notes/ Special Conditions
-
Ef-See note on back regarding River Basin rules.
V,
Agent or Applicant Printed Name ie pTnit Offi-cer.'s Signatu re
2 4 20H,
Signature ** Please read compliance statement on back of permit" Issuing D I ate /plExpiration Date
50 W'rehead
Application Fee(s) Check # Loci] Planning Jurisdiction Rover File Name

A.
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 '- ecome
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 [)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:
E Tar - Pamlico River Basin Buffer Rules El Other:
El 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:
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,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

ADJACENT RIPARIAN PROPERTY OWNER STA.TErVIENT
I hereby certify that I own property adjacent to
2E L /Jr S�
(Fame of Property Owner)
property located at
(Lot, Block, d, etc.)
/ C.
on (Waterbody) (Town and/or County)
He has described to me as shown belu,ti', the development he is proposing at that location,
and I have no objections to his proposal.
ESCRXPTZON ANIIJ/OR DRAWING OF PROPOSED DEVELOP SENT
(To be filled in by individual proposing deielopment)
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Signatur
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Print or Type Name
&'�-/ 0 (' �' �-- =1 C) !� f .-
Telepho',e Number
Date: -:� -- ':� Y-
-29-

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T .
ADJACENT RIPARIAN PROPERTY.' 0M\ER STA.TEIIILI�T
I hereby certify that I own property adjacent to
' (N2rne of Proper-ty Owner)
y,
pro?er� la�2tec1 at
(Lot, Bloch, Road, etc
r
on 'y� /340 � �) (1/'?'e. A_._ , in ` � /d'�ui �� — N. C.
(Waterbody) (Town and/or Count}-)
1 He has described to me as shown belo�.4-, the develops -gent he. is proposing zt that location,
Ii
and, I have no objections to his proposal.
r,
'G
Ix
CRIPTION AND/OR DRAWING OF PROPOSED DEVELOMMEW
(To be filled in by individual proposing dey,elopme4.--- 6'—"j
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%Zc'ti,I-,
Sicnature
Print or Type Name
Telepumber
Da?e: /— 9-2 - o.6

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