43633_DEVITA, STEVE_20051208

CICAMA•/ DREDGE & FILL l/
GONE L PERMIT Previous perm#,�
❑New F 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 !'
j ❑ Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot (s)
City
Phone # ( )i
Authorized Agent
Affected L CW
AEC(s): -1 OEA
❑ PWS:
ORW: yes / no
State ZIP
Fax # ( )
i❑ EW ❑ PTA ❑ ES ❑ PTS
7 HHF f_ IH UBA ❑ N/A
FC:
PNA yes / no Crit. Hab. yes / no
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 _
SAM 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 o� Applicant Printed Name
Signature "Please read compliance statement on back o(permit
Subdivision
City
Phone #
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
River Basin
nat man unkn)
(Scale: )
See note on back regarding River Basin rules.
Permit Officer's Signature
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, 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
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 RIPARLAN PROPERTY OVYINER STATENEEN'T
(FOR A PIE'RIAIOORING PILINGS/BOAT LIFT/ROATHOC'SE•)
[hereby cer-j y that I own property adiacent to VtAa �s
(Name of Property O ner)
prooerzy located at 3 d S ck a r' nt I I)Vlu c .�.
(Lot; dock, Road etc.)
4o �
(Waterbody) (Town and/or County) -
He has de&--nibed to me, as shtown below, t: e deve'.opmen� he is propcs:-._ E7 t; a[ loci "lion,
and, I have no objections to his propose. I un,"e-S and t=.a: pier/moorInE
pizin7&boarlir-vbeathouse must be se: tack a ni ,im�!m dis- .nce c t zzz fee: (:i) from my a ea
of access unless waived by -me.
I do not wisp to w_ .e t e sz;back reou''iremenc.
I dn -wish to vva?,ve t`al s-.bac
DESCRIPTIOti A.'N-D OR. DRAWD G OF PROI -D DEVELOP`IENT:
(To beJ!Zled il- by iindi>idur.I procoss rqg e opmenr)
Ifl an To 6,A1�l cL OrSea wpall " rYv+� °warn 1! ire a F�' ,
SIA. �,..
1 S' (;'" I,
ot tI
to 6u+1d a
por,,4- '76 rowers po144-
- NLv M : 14: A Ltja�,. N aL)(-
1. s-r . ( l
--------------------------
Sit•
e �' v
Pi ir,t or Tve N-cme
Te!zpF�o�-ti::.mb.:
C OQ b+ G'j 0, d
C�4nnt!
c

' ADJACEiv'T REPARLAN PROPERTY OWNER STATENMEN'I'
(FOR A PIER/MOORING )>ILING,SIBOATZIFTIBOATHOC'SE)
I hereby cer'� y that I own property adiacent to S}aue
(Name of Property Ov ne;T
prooe. zv located at 3 0 S Ck a v-, nc l j) VIu c
(Lot; Mock, Road, etc.)
on Coas+ C740d Ckgoi ►t-I , in Cn ItZ4IJ t C- , N.C.
(Waterbody) V (Towit and/or County)
He has described to me, as shown be!o,,4-, the davelopme:,i he is pro; ';s:"._ r: t iai localon,
and, I have no objections to his proposz-1. 1 u:,ee-3,"and pier/rnoorinE
p li;�s, �oaurvbaathouse must be sz: back a minimum dis=ce of t : e-n fee: (' 5') from my area
of access unless waived by -me.
I do not wish tothe se'back rl-quire r:eni.
!/ I dn_ wish to wa'I"Ye rat se.bac J ion 5e,t v,t)l or RAIL oqi
DESCRIPTIOcti A.'N-DiOR DRA"'EN G OF PROPOSED DEVELOP%Ii.\-T:
(To be filled i : bv individual proaos-r a ceve rpmenr)
6 AA►11 CL it S C a wall " Rvwx ? 06 n+ "IC ♦o V A C 04 6� &" O v c
Cn '{{ i�'ri�►1 Po�r�� 09 rOWis pot�T�da�� 1 Ir sow C42nme
i7 x J Sj "_
C /P•_ ` i 1 J
_ 3
u; P_e'. Mores
Signaru
PIin-, or Ty, re N::ne

JAMES F= DAVIS NCDL 5446287.
DBA SAd ES MARINE CONSTRUCTION
PO BOX 1264
SWANSBOR0, NC 2a584
hPay to the
Orae�rr
2416
66-301531
Date 341
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RST ITIZENS 3 33�
S+� BANK
V First c Uzons Bank & Tru�mparry
'� V/WW ro, N.C. 28594
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For
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GUARDIANO SAFETY YELLOW WDYE
®U'arke American