46794_CANNON, CONRAD_20061026

❑ CAMA / ❑ 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
and the Coastal Resources Commission in an area of environmental
concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name
Project Location: County
Address y'
Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O Fax # O
Subdivision
Authorized Agent
City ZIP
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
Phone # ( ) River Basin
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body (nat /man /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)
Finge
(Scale: a )
r pier(s)
Z / CUUb
Agent or Applicant Printed Name Permit Officer's Signature
Morehead City DCM
Signature ** Please read compliance statement on back of permit Issuing Date Expiration Date
Application Fee(s) Check # Local Planning Jurisdiction Rover File Name

Aw
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 ❑ Other:
j _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 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/ 1-888ARCOAST
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

i
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
s�lzz
-- CONRAD CANIVOt4 72&- - is property
located at 41 q N. K' 4I ;TO/4 AU1 on
(lot, Block, Road, etc.)
'moo JUE SOu sd o
A e C E.ss uA NN E �- _ in A` -Wn-1 e- *56A ? 4 N. C.
(Water Body) (Town and/or County) 7-45s!y
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his proposal. I understand that a pier, pilings and
dredging must be set back a minumum distance of fifteen feet
(15') from 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.
DescriRtion and/or drawing of pro o� sed_develo-oment:
(To be filled in by individual proposing development.)
'26LOCAT� C-xi S-rIn19 /'4 •x /6 • S� rrlu9 VaCt< AND 5 - 14' Fr HgER DoC,C
t AJ NEW Lo eAT(o M ALamq <45A&-)A iLL- Ag 1 fll,J' 1CA-rE0 V61-0c.J .
Scz-rrt"g of TmizoE MC--rw 07,aalk,,49 -PILIAVc ; 4'01trr^ rRVA" SEAr.J4L1-,
ER'C f'r49 LoC4Y�oM
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IS• Z�' ' Ili"---7--�-g� i
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Date Phone Number

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1O/1912O06 11:54 FN FROM: FaK excalibur solutions ins S0: _252"26-e089 PAGE: 001. OF 001
ADJACENT RIPARIAN PROPERTY CWNER STATEMENT
I hereby certify that I own property adjacent to
!(�dNRA.P_ t4't?+ ' s property
located at +-ffq N. KtnFSo�# AVc. on
(lot., Block, Road, etc_)
Sou NO
JWater Body) (Town and/or County) zpsr2-
He has described to me as indicated below the development
he is proposing at that location and I have no objections
to his..prp sa:l. I:unaers.tzand .that a pier, pilings and
. . _.... .
cix6897 inq mu't be set<.b�a k z;a m numum di�tarite<of fifteen feet
(15') from. my area of riparian access unless waived by rye.
a do not wish to waive that setback. requirement.
I do wish to waive that setback requirement.
Waiver onq with a setback of 7' to 101 feet
Description and/or drawing of proposed development=
ift be filled in by individual proposing development.)
WLPCA-FL- 6 x 4 C r11*2 14 x 11,' r b-rT-f t!g Z7vCt< AND 57s 14' A-, ope=R V ce
iN NLca LacAr4oN ALovq --CA60 4_L AI3 )f'VI0_Ar-EO !Of_:L0Cd.
S6TrtuCf OF TAR W nK-W 07e si2r'►9 'PILtNOC "' OC"r F947101 S5nW4 LL .
`Tj_ ` 120
LK.C'Vi.a9 L,oC4Tra,.i
aQ �oCr.S
1-71
ALfq
T
� i t
Contact address:
1436 Vauxhall Rd.
41
Union, NJ 07083
Si n tur 7'
Waiver�oni wit�i/a setback of to 1A feet
1
J
W
/
Print Name / j
(-: Fes/
Z
"ate
Phon�a-• Number

Ad nmu
Of Awt-,
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director 1f}illiar^, G. Ross Jr., Secretary
Date`
Applicant Name 001y1:ZA D 0
Mailing Address / 7 �/ /�'/�% S 7't�•��
I certify that I have authorized (agent) _ 1 1AS to act on my
behalf, for the purpose of applying for and obtaining all CA -MA Permits necessary to
install or construct (activity) "DOC�Y=�
at (location) ( i✓I!.(S� T��l tr_ - -
This certification is valid thru (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www,nccoastalmanagernent.net
An Equal Opportunity 1 Affirmative, Action Employer - 50% Recycled 1 i o% Post consumer raper

R. J. DOLGAS EQUIPMENT FUND 1589
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PO BOX 3355 66-30/531
ATLANTIC BEACH, NC 28512Date Z 'LdU �0 133
Pay to the -
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n nnJjj' Firs
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