55718_FOWLER, PATTI_20100505

'---'LAMA / 1 i DREDGE & FILL
GENERAL PERMIT Previous permit#
❑4N'eW 6 ❑Modification ❑Complete Reissue El 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 I SA NCAC�-
ules attached.
Applicant Name --t i� Project Location: County I' - �� T .11"
Address
tt ' / ! 3 ! 't / > Street Address/ State Road/ Lot #(s)
City k .t t ` L State ZIP
Phone # ( ) j r Fax # ( )
Authorized Agent
Affected ❑ CW ❑ EW UPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA C HHF ❑ IH UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / :no Crit.Hab. yes / no
Subdivision
City r t ZIP
i
Phone # ( ) River Basin (<
Adj. Wtr. Body ' ': f tt_'' 0 A,), I -i C `� ' (nat /man /unkn)
f
Closest Maj. Wtr. Body F l� S
Type of Project/ Activity n X
(Scale:
Pier (dock) length d
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
— P "J
Shoreline Length
IIi
4
SAV: not sure
yes
no
Sandbags: not sure
yes
R-q
Moratorium: n/a
yes
no
? )
Photos:
yes
(
l
111
Waiver Attached:
yes
iho—------
t
1f.L'
A building permit may be required by: t 1. L1 i ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions if t ( �( { I �' , f I 3 �� f ] U-11 Ox,
,
Agent or Applicant Printed Name
r
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
The time period requirement for this
development is suspended until 12-31-
j t 2010, pursuant to Senate Bill 831. The
Permit Officer's Signature effective date of expiration for this
permit is
Issuing Date �-� Expiration Date
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 I) 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
Raleigh Office
Morehead City Headquarters
Mailing Address:
400 Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
W =2L0 W01115, SIV
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
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)
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 08/09/06

Applicant:
Date:
c
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp im acts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other Le"
Dredge ❑ Fill ❑ Both ❑ Other ❑
0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge U Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIF,TIBOATHO USE)
I hereby certify that I own property adjacent to I� riv l//W s
(Name of Property Owner)
property located at c23 O & %d
(Lot, Block, Road, etc.)
on l oLO 7 -ej Ceek\ , in e4LLt-�vr-7 CLtcr e N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: BUT — 7 c1D Mailing Address:
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
'`aFr
It, 4pl�J99
------------------------ -----gay-- ?%'
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEkOPMENT: `4-®,
(To be filled in by individual pioqsbig development)
-----------------------------------------------
(Information for Property Owner Applying
for Permit)
3069 �JL-70
Mailing Address
e 2",� / l/u C a�
City/State/Zip
8r �— gD
Telepho e t b
Cc4)
IPAkV,
t
(Riparian Property Owner Information)
Signature
Print or Type Name
Telephone Number
/(--7©R
Signature Date Date

,
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Q` r �i [r r— is
(Name of Property Owner)
property located at 30&
(Lot,tlock, Road, etc.)
on 00yJ Tec► OiP� i in �6e C" f kre- 7— , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Z0775 — /Z Mailing Address:
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement. 4,+0 t7,?o
---------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWIN9 OF PROPOSED DEVELOPMENT:)'�Dc,,
(To be filled in by, indiN4zal proposing development)
(Information for Property Owner Applying
for Permit)
030(a IC
Mailing Address
/UC ass
City/Stat/Zip
elep e Nu -e
Signature Date
--------------------------------------------------
(Riparian Property Owner Information)
Signature
go bert K S e i lers
Print or Type Name
2 i2 - ri2,3- 3g8r1
-W--20/0
Telephone Number
Date

PATRICIA K. FOWLER
NCDL 2022824 728-7908
2306 HWY 70 E
BEAUFORT, N/C28851(66
PAY TO THE
ORDER OF
•
CND
-C
vfC
3640
66-7704/2531
DATE
$ goo. db
/.aiusY
DOLLARS
State Employees' Credit Union
Morehead City, North Caroli
62 na
Y
i:253L77049i:08625395897u' 361,0