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❑CAMA / ❑DREDGE &FILL
2)7
GENERAL PERMIT -Previous permit #
❑New ❑Modification []Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural tRources -and the Coastal Resources Commission in an area of environmental concern pursuant tNCAC
Applicant Name s=rr_-t"
Address
Cityf; t'!�� State
Phone # ( Jlij/iGg Fax #
Authorized Agent c V.,\i '
Affected ❑ CW ❑ EW ❑ PTA [j ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
54608 k �
E] Rules attached.
Project Location: County _¢
Street Address/ State Road/ Lot #(s)
Subdivision
City j R 3 ✓»
+~ cep. L%. �. '; i ZIP r . .✓�rfi�'
Phone # () River Basin✓� l A �t�
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Agent or Appli{cant Printed Name
Sigpature
(;�' Please read compliance statement on back of permit
1W17
Application Fee(s) Check #
Permit Officer s Signature
Issuing Date .,.. -mil Expiration Date
Local Planning Jurisdiction Rover File Name
I
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 thatthis 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: 252-247-3330
2728 Capital Blvd. (Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604 New River Inlet- and Pamlico Counties)
919-733-2293
Fax:919-733-1495
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:910-395-3964
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06
ADJACENT RIPARIAN PROPERTY OWNER STATENMNT
(FOR A PIERMOORING PILINGS/BOATLIFI'/BOATHOUSE)
1 hereby certify that I own property adjacent to I t-t
(Nance of Property Owner or Applicant)
Mailing address if different from location address OS�JC�-T �j LEI
(town, state and zip) ff)bt4'fit q a
phone numbers you can be reached
property located at Q 7 mtfp) ► z,1 A ME�p % M6 bt �Jc_
(Lot, Block, Road, etc.)
onS in i�-�I Yn�rl C
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. 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
wai ed by me. r
. ,.
<:
A IYeah Lo , aivc. tti-: s:,tU�c:K
iare
I do wish to waive that setback requirement.
initialsMoreheed City DCM
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
f- L ------- - ---- ------- ------ -
-------
int or Type Name
XZ' �--6'3y
lephone Number
ADJACENT RIPARIAN PROPERTY OWNTER STATEMENT
1 hereby certify that 1 own property adjacent to 's
(Marne of Property Owner or Applicant)
Failing address if different from location address s )q 6 LL
(town, state and zip) _ t4?-.'bt �Jl C �' 1 6
phone numbers you can be reached I r7 t
property located at Z- R 7
(Lot, Block, Road, etc.) p
on �L �� , in �I�)� , 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 obj ections 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.
�. 44
I d• not wish to waive the setback requirement. AUG l 4 2009
initial
initials
I do wish to waive that setback requirement.
Morehead City DCM
DESCRIPTION AND/OR DRAWING OF PROPOSED DE LOPMF-NT:
(To be filled in by individual proposing development)
L:C�
- --- -- ---------------------------- ------ --------------- ----- ,------- --- --
14�
osC (j ien re
l 1 . int or Type Natn:
X 9/g- 678- /*ZO
.elephone Number
ri
a
AF,
,r''R
idol Lh Carokna Depth -newt of Eavir enment and I M LUI a! D Iv raeGe��cp�
_ �A a
Michael F. Easley, Governor
hades S. Jones, Diractor William G. Ross Jr,, Secrel,ry
Date
�•.a- 09
A.ppiicant NaAaai
MaiiAna Addn PSS
to act on irg'.-
I certify that I have autborized (a-eAnt)
behalf, foA- the purpose eva appiying for and obtaining all C�1`,�.A. Pen-Anits necessary to
install or construct (actaViay)at (locati,n) L=
This ce' nfncation is thru (date)
,SArAAature
:111 ES
AUG 2 d 2009
;Morehead City i)CM
R & j GROUP 1417
P. O. Box isss
Morehead NC 28557 66-112/531
2525722A253
Fealurea
Oe�aili an
�ck.
m BRANCH BANKING AND TRUST COMPANY
1-800-BANK BEIT BBT.c0m
�- c�``�k
FOR
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