44507_CLARK, JAMES VAUGHN_20060222

='CAMA.j 'DREDGE & FILL
GENE L PERMIT
��Nevv 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_
3 46 /--5 -'s
Previous permit #
Date previous permit issued
❑ Rules attached.
Applicant Name_ Project Location: County_
Address — —_ _ _ /ti Street Address/ State Road/ Lot #(s)
City -( State ZIP L
Phone # ( ) Fax # (`) Subdivision
Authorized Agent City,____
Affected CW EW PTA ❑ ES L PTS Phone #
AEC(s): OEA HHF F' IH ... UBA _I N/A Adj. Wtr. Body_
PWS: L] 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
SAV: 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
Agent or Applicant Printed Name
l
Signature ** Please read compliance statement on back of permit
Application Feels) Check #
ZIP -- —
_ River Basin
_—(nat man unkn)
i
(Scale: )
_ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
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 consistentwith 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 Environmen .al Ma; agement 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 Cif District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location: Fax: [phone]
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J pgAt iF1 V1yG#� e 4,¢21<rs
(Name of Property Owner)
property located at 4 ,4A,)J— , Qy6-�� ,JG L©7—WAY I
(Lot, Block, Road, et .)
on 0A":5
c° /2 �+ , in BTW/+Y — G°li/zl �/Lr�/ , N.C.
(Waterbody) (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.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signature
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Telephone Number
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -'FA t,95 V110e- A-) AV-'- lz1< 's
(Name of Property Owner)
property located at 4 / l- C: �- A+A /�. t, A gip , (0 TwJ1!y)
(Lot, Block, Road, etc.)
on 10PP-D5 Gd2£�K , in_ 07'1-3R `1 Lc19,-zi e//�T� , N.C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is roposing Fon,
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and, I have no objections to his proposal. FEB 2 7 2006
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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------------------------------------------------------------------------------------------------
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Signature
Print or Type Name
02 �7a e?
Telephone Number
Date:

JAMESV CLARK
J)BA COASTAL RIVERSIDE CAMPGROUND
216 CLARK L-N
13EAUV()R-T, t4r, 28516
5797
66-112/531
02001
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