43530_EVANS, BARBARA_20051114

ate- ; .ems
JCA.MA /-- DREDGE &FILL // �"�e�e�+e3►®
GENERAL PERMIT Previous ermit#
❑New ❑Modification F]Complete Reissue LIPartial Reissue Date pr ious 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
O Rules attached.
Applicant Name Project Location: County
Address_
City `'r ' '-� State I t ZIP
Phone # ( ) . Fax # ()
Authorized Agent ✓ I ` r } "'%
Affected ❑ CW U EW F+PTA RES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no: Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s) __
Groin length
number
Bulkhead/ Riprap length _
avg distance offshore
Street Address/ State Road/ Lot #(s)
iL+
Subdivision
City 1 ZIP
Phon-f ( ) River Basin
�0—
Adj. Wtr. (nat /marri unkn)
Closest Maj. Wtr. Body
max distance offshore
Basin, channel_ '� a
cubic yards
Boat ramp _
Boathouse/ Boatlift
Beach Bulldozing
Other----
�'
Shoreline Length -f- b
_
SAM not sure yes
no,
Sandbags: not sure yes
/h `
Moratorium: n/a yes
'n
Photos:
go
Waiver Attached: 6ye
no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
l� far
Signature Please read complia ce statement on back of permit
Application Fee(s) Check #
(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, 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: 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)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Morehead City District Wilmington District
400 Commerce Ave 127 Cardinal Drive Ext.
Morehead City, NC 28557 Wilmington, NC 28405-3845
202-808-2808/ I-888-4RCOAST 910-796-7215
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -above (Serves: Brunswick, New Hanover,
New River Inlet- and Pamlico Counties) Onslow -below New River Inlet- and
Pender Counties)
Revised 06/29/05

ADJACENT RIPARLk,N PROPERTY OWNTR STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIF 120ATHOUSE)
I hereby cerdfy that I own property adjacent toLIC UZ461 's
(Name of Property Ov*ner)
property located at /9S- 04 K/eat
(Lot; Block,
// Road, etc_)
on _PKS �%rwa % , in /O;Ne kwll 5h&,v-S f c la-f— , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shlown below, the development he is proposin a_ that location,
and, I have no objections to his proposal. I understand tr,a. a pier/ moorinQ
pilings; aoatlirr/boathouse must be se, back a minimum distance of from my area
of rpa-ian access unless waived by me.
I do not wish to wa:vc the setback requirement.
I do_ wish to waive t;.at setback recuirement.
DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEtiELOPNtE\7:
(To be filled in by irzdividual proposing development)
,Dxs Cam!
3i _3
1 •Z
1 ess _ — —f' IcsstlJ�nt��1�—
Z_� 2-)
Telephone Dumber
,1JT'
/a le
$_.

ADJACENT RF-PARLMN PROPERTY OWINIR STATEN ENT
(FOR A PIER/MOORING PILINGSIBOATZIFTIBOATHOCSE)
I hereby certify that I own property adjacent to �z�� �vti►,v s
(Name of Property Owner)
propery locatedat /9 5- 014K /eke 41J.,
(Lot. Block, Road, etc.)
on PkS , in A&if &,e/l sjoc,es C-frue4-- , N.C.
(Waterbody) (Town and/or County)
He has descr-oed to me, as shown below, the development he is proposi-_ a_ tl at location,
and, I have no objections to his proposal. I unders=d tha7 a pier, mooring
piiinas;boatlif-Jboathouse must be set back a minimum distance of fliLeen ftt: (I5') Fom my area
of rp2=1an access unless waived by me.
I do nnt wish to wa,,-e the setback reauiremen.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWr G OF PROPOSED DEVELOP`IE\-i:
(To be filled in by individual proposing deve7oamerzr)
fts C-aNa
�,,L�Zip _ '3�_
—
Qles
,�
4�wu '
StEnature
JJ0P1 �e�1e �S 5
Print or Type Name
'"'�-'1�4-- Cie
Telephone Numbe-
/O 1
S

5578
BARBARA E. EVANS 66-211530
195 OakleaKnoll f j l BRANCH 77614
Pine Knoll Shores, NC 28512
Dalc
Pay to the � Li _ _ � $ lXi4 Q
Order of
7 Dollars
WACHOVIA
-r
WachoviagBank, N.A.
�h�
Rrr_
,:053000219i:L054E,21975L90i" S578___