46721_ANGSTADT, LINA_20060925

GL�—AMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources /
CA —
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC VL
Rules attached.
Applicant Name c- ! Project Location: County ( i
Address (' Street Address/ State Road/ Lot #(s)
City ' ' I State ZIP
Phone # O Fax # O Subdivision
Authorized Agent City ZIP r
ElCW ❑ EW ❑PTA ❑ ES ❑ PTS Phone # ( ) River Basin ✓ ` �A
Affected ❑ OEA ❑ ❑ El IH UBA ❑ N/A r
AEC(s): Adj. Wtr. Body ( 1A L4ha , unkn
❑ PWS: ❑ FC:
Closest Maj. Wtr. Body �!� /^�
ORW: yes / no PNA yes / no Crit. Hab. yes / no i
Type of Project/ Activity
Pier (dock) length
Platform(s)
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
$AM 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
(Scale: /I/ ?I )
_, ')ee note on back regarding rover tsasin roves.
Agent or Applicant Printed Name y it Officer's Signature
Signature Please read compliance statement on back of permit Issuing Date Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction 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, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
0 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax: [phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
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

ADJ ACEMY RIPARIAN PROPERTY OWNER ,S'1 A] -ME T
(FOR A PIER/MOORING PILINGS/BOATLIF7'1BOA7I101 V)
I hereby certify that I o« ii property ad acent to
(Nance of Property Owner or Applicant)
Mailing address if different from location address-/1G1_c�'I19c_t_� 214,4-_ __21'_1__✓�.
(town, state arld "I_Ip) �� � ��±t-Yi _._/ `L. �_. —Z-7 -5 -5..�.-
phone numbers you can be reached at'9 )ci \� O +S
ro ert located at O yam - 'x 7s
s
(Lot, Block, Road, etc.)
on�3- Ir50L-
(Waterbody) C 4 K, N L (Town and/or County)
Ile 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 piliiigs/boatlift/t)oathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
unhats
W 7 I do wish to waive that setback requirement.
initials
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Print or Type Name
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Telephone Number
Date: 3 O
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
reby certify that I own property adjacent to
is property
at ! <S j rn 1 t Ez-�, tiT , on
(lot, Block, Road, etc.)
_in PLpN4 -�. B6-pt& 1 , N.C.
ater Body) (Town and/or County)
y1has described to me as indicated below the development
heproposing at that location and I have no objections
to 10 proposal. I understand that a pier, pilings and
dre '.ng must be set back a minumum distance of fifteen feet
(15lifrom my area of riparian access unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development:
o be filled in by individual proposing development.)
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Dat
Signature
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Print Name
Phone Number

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