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❑CAMA / ❑DREDGE &FILL
GENERAL PERMIT
Previous permit #
❑New Xkodification [-]Complete Reissue ❑Partial Reissue Date previous permit'''sued
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
❑ Rules attached.
Applicant Name_
Address
City
Phone # ( ) _
Authorized Agent
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes / no
04
State ZIP
Fax # ( )
❑EW El PTA
❑ HHF ❑ IH
❑ FC:
PNA yes / no
Type of Project/ Activity
Pier (dock) lenoth
Platform(s)_
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
avg distz
max dist
Basin, channe
cubic ya
Boat ramp
oathous
Beach Bulldo:
Other
Shoreline Len
SAV: ni
Sandbags: n,
Moratorium:
Photos:
Waiver Attacl
A building permit may be required by:
Notes/ Special Conditions
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit. Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City /-Cr A ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale:
❑ See note on back regarding River Basin rules.
V • .II LL 0 5 2006
Agent or Applicant Printed Name Permit Officer's Signature
AAnrahmAd City DCM p
Signature Please read compliance stateme on ac o permit *'WIssuing Date Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File Name
1
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:
El 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 (910-796-7215) 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:919-733-1495
Fax:252-264-3723
(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: 252-247-3330
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05
rRoM : CGtG 00 : ENTAL FAY N3. : 252249266:3 '1dy. 23 2096 03: 12PM F2
ADJACENT RIPARIAN PROPEPTY ()jjr XR STATEMENT
i hereby certify thet I Own property'sdjtteent to l --...f
'am of roperty Owner)
property betted at .203 rlffc )T
(Lot, Bf Road, etc.) 1
PO . / Nx.
in
1!1Vaterbody} (TOltin tnd/ Ceunty)
He has described to rtte 25 shown below, the development he is proposing tt that location,
and, I have no objections to his p(Oposel.
DF,SCRIPTION AND/OR DRAIViNG OF Y.V)POSED DENT1.OPJN'r-N7
(ro Lrfilled in by' lndisidrtal proposing de1Wopnrent)
h%,,�sc l't. i vim•..
• MMLI
-mot
apt• J4o�..� — —, �P�OW-
Signe:urc
Ytini or ?)•pe ?�zme
—29-
7etcpho:�c Numb'r
Date;
y
Er-0
BIJUN 12 2006
MarphoRd Gity PGM
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Jun 07 06 12:24p Rebecca Bleau 252-633-3407 p.1
mad 27 06 0102p Bob 6 Missy Baskervill 252-249-JbJY P•1
ADJACENT RIPARIAN PROPERTY 011WER STATEMENT
I hereby certify that I own property 2djacent to n/mTo
Pro
I"Of—I
ty ►s
proper) Ioc2ted 2t 203 01 1VC R__
(Lot, Vock, -Road, etc-)
/ �2t2 "mot U`CJI in
on /J(+vP,v� , I.C.
{%yaterbo3y) (Town and/ r County)
He has described to me as shown below, the development he is proposing at that location,
and, 7 have no objections to his proposal.
DESCRIPTION Al\'D/OR DRAWING Off' p�.OPOSED DE
(To be filled in by indi t•idelal proposing derelomvent)
IMI
5:2. - §,'-f q 3 53 -7
3 AOL
Si -nature
?�kIca
Print o: Type Na-me iy>oG�/e-
Telepho:5e Xumber
Mtc: —6 /_ �/_l
JUN 1 2 2006
Morehead City DCM
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