44741_BROCK, DAMON_20060321

-ICAMA /,-!DREDGE & FILL
GENERAL PERMIT
❑!New ❑Modification .❑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 15A NCAC
PrevibU permit #
Date previous permit issued
f Rules attached.
A licant Name I ,I op, �� r . `t Project Location- Coun {
PP - l
Address
City
Phone # O_
Authorized Agent
Affected ❑ Cw
AEC(s): ElOEA
ElPWS:
ORW: yes / no
State ,t/r Z1 P t' 76
DEW
i HHF El IH
ElFC:
PNA yes / no
Type of Project/ Activity
*S ❑ PTS
❑ UBA ❑ N/A
Crit. Hab. yes / no
r
Pier (dock) length
Platforms)k
Finger pier(s)
Groin length
number _ — ------ -
Bulkhead/ Riprap length
avgdistance offshore ma
max distance offshore —
Basin, channel . i ,i + �a -
cubic yards
Boat ramp
e !'
Boathouse/ Boatlift -
- - =t
Beach Bulldozing
Other-
Shoreline Length
j
SAV: not sure
yes �nl
Sandbags: not sure
yes n
Moratorium: n/a
yes
Photos:
yes
Waiver Attached:
yes nq {
A building permit may be required by:
Notes/ Special Conditions
1t-I,.r;,
K4
1 tY
Street Address/ State Road/ Lot #(s)
Subdivision
City_�r f . _j 'rt ZIP
Phone # River Basin t
Adj. Wtr. Body_ - � !'t ' �' ' ' (nat /man /unkn�
Closest Maj. Wtr. Body
(Scale: A/ )
K +
Ir1
❑ See note on back regarding River Basin rules.
006 v -
Agent orAp licant Printed N e Permit)D,Mcer'sSignatureVi J/,/
D/ ,
Signature Please read compliance statement o a o i • `y Date xpiration Date
ApplicationFee(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 L ] Other:
[J 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/ 1-888ARCOAST
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

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Form DCM-MP-1
site. Include highway or secondary road (SR)
numbers, landmarks, and the like.
• A Stormwater Certification, if one is necessary.
• A list of the nmw and eon"dete addresses of the
adjacent waterfront (riparian) landowners and
sinned return reeelpts as proof that such owner
have received it copy of the application and plats
by certified mail. Such landowners no be advised
that they have 30 days in which to submit commew
on the proposed project to the Division of Coastal
Management. Upon signing this form, the applicant
further certifies that such notice has bees provided.
Name
Addre
Phone
Name
Addre
Phone
Name
Address
Phone
• A list of previous state or federal permits issued for
work on the project tract. Include permit numbers,
permittee, and issuing date&.
• A check for SM made payable to the Department of
Environment, Health, and Natural Resources
(DEHNR) to cover the coats of processing the
application.
• A sipped AEC M=rd notice for project: in
oceanfront and inlet areas.
• A statesnent of r n plianoe with the N.C.
Envirw mental Policy Act (N.C.G.S. 113A - 1 to
10) If the project involves the expenditure of public
funds or use of public landi, attach a statement
documenting compliance with the North Carolina
Environmental Policy Act.
J-03 V/ S�"
6. CERTIFICATION AND PERMLLSSION
I understand that any permit issued in response to this
application will allow only the development described in
the application.. The project will be subject to conditions
OW restrictions contained ;-I the permit.
I certify that to the best of my knowledge, the proposed
activity complies with the State of North Carolina's
approved Coastal Managenumt Program and will be
conducted in a manner consistent with such program.
I certify that 1 am authorized to grant, and do 0 fact,
grant permission to representatives of state and federal
review agenda to enter on the afor nod lands in
connection with evaluating information to this
permit application and follow-up nwnl of the
Project.
I further certify that the information provided in this
application k truthful to the best of my krldwledge-
This is the day of . 19
Print Name
Signature
lrkdowwrr or Awdiork d Agaw
Please indicate attachmeu>t: pertaining to your proposed
project.
DCM MP-2
Excavation and Fill Information
DCM MP-3
Upland Development
DCM MP-4
Structures Information
— DCM MPS
Bridges and Culverts
_ DCM W-6
Marina Development
NO?'1i~ Please slam and date each attacuww in alit
ipam provided at Ow bonan of eaalt j6rrmr.

DAMON A: BROCK
GREGORY C. JARRELL-
7825 HARDWICK DRIVE-
RALEIGH, .NC 27615'
66-46/53t 1196
100M976810
DATE 3: z I Ze 6
PAY TO THE . �n `- ..
ORDER OF >D Qr rl / MQ l�%(r t /' l i
DOLLARS
oled.
SV1V 1`1llJ` Sl ACH RT0610001 -
MEMO Ir7cQ„f'M� �i_r.l� 4�!
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