44716_BURNS, CHARLTON_20060314

CAMA / iD DREDGE & FILL 0},j
GENEF#AL PERMIT " Q
Previous permit # 14
i._!New r Modification ]Complete Reissue -]Partial 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 15A NCAC
❑ Rules attached.
Applicant Name r Project Location: County _____________
Address Street Address/ State Road/ Lot # s
City. i l ;?,-w /319-11f-A State Aj(. ZIP
Phone # 7 Fax # (�) Subdivision
Authorized Agent -)�k1---- City- C ZIP_ ' R`
CW ❑ EW ❑ PTA DES ❑ PTS Phone # (_) River Basin
Affected OEA Li HHF ❑ IH ❑ UBA El N/A �.
AEC(s): Adj. Wtr. Body _(RatIman /unkn)
PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
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/ Boatlift
Beach Bulldozing
Other
Shoreline Length _
$AM not sure
Sandbags: not sure
Moratorium: n/a
Photos:
Waiver Attached:
yes no
yes no
yes no
yes no
yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Pri ted Name 0
Signature Please read compliance statemeny`on back of permit"
Application Fee(s) Check #
(Scale:
r
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
LG - 414
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
landowners).
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 _� 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: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
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 STATEMENT
(FOR A PIERIMOORING pI'LINGSIBOATLIFTIBOATHOUSE)
t hereby certify that I own property adjacent tl'
(Name of property owner)
property located at _ '�) I' % --
(Lot,'block, road, etc,)
ater body} nd/o• N.C.
(Town ar 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.
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)
woo &Q Clete.
f � '( jrfiv� •
'
Foley & Foley Contractors, Inc.
Phone#: [phone]si
aforeji�7
^y-
FaK#: [phone]
Print or Type Name
Telephone Number and Date
110"d Vd HdO s-xa6O2j V LaVgZ3LW VZ1 = TT 90-L0--AVW

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOIISE)
I hereby certify that I own property adjacent td�� 141:2 1c�J s
(Name of property owner)
property located at=
(Lot,'61ock, road, etc.)
o r cstZ IYt , in 1' F -eJ / ,�� �.�.�...c_� , N.C.
ater body) (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/boatliftlboathouse 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.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(to be filled in by individual proposing development)
94%w0.S at le - gcj*pC
P
ti
} '1J
s
s/ f
y
Foley & Foley Contractors, Inc.
Phone#: [phone] Signature
Fax#: [phone]
Print or Type Name
Telephone Number and Date

FOLEY & FOLEY CONT5RACTORS INC.
10 OLD AIRPORT RD.
N1EW BERN, NC 28%2
PAY
TO THE
ORDER OF
AfElvc/`
DATE Q
Busi s Value Checking
BRANCH BANKING AND TRU ITCOMPANY NP
FOR �`�� t —c� i2✓t r (ic�I6��ti2�'J --- --
u'0000 2 7 7D11' I:0 5 3 10 L L 2 1 :000 5 2900 5 L
2770
66-112/631
BRANCH 01901
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