54197_GUTHRIE, BILL_20090708

❑ C MA / El DREDGE &FILL 5 11 T'_ -
G9NERAL PERMIT 4% A New Modification Complete Reissue Partial Reissue \A/�
Previous permit #
❑ []Modification ❑ 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
[] Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP i
Phone # O - Fax # ( )
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Subdivision
City_ ZIP 1
Phone # River Basin
Adj. Wtr. Body (nat /man /unkn
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officer's Signature
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 [)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
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/ 1-888-4RCOAST
Fax: [phone]
Location:
(Serves: Carteret, Craven, Onslow -above
2728 Capital Blvd.
New River Inlet- and Pamlico Counties)
Raleigh, NC 27604
919-733-2293
Fax: [phone]
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Y s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on , in N.C.
(Waterbody (Town and/or County)
Applicant's phone 91,3 O 3 S Mailing Address: P4 /
He has described to me, as shown belw, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION
(To be.
------------------.--------------------------------------------------=-------q V�
/OR RAWING OF PROPOSED DEVELOP %
in by propr-spas' t)71evelqpmen
200,9
,,7 to K" K lid R- p�
4e41--;e sorehead City CCM
rzs ( P
01}
� 1
-----------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
�/�G1i91 A-
Mailing Address / nature
City/State/Zip Print 6firype Name
g,3S /sS38'
Telephone Number
Signature Date
Telephone Number
Date

It
El

l
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
ha e no objections to his proposal.
------------------------------------------------------ "---- �M-'"
-- =----'�--- ----------------------- --=
S RI TI /OR DRAWING OF PROPOSED DEVELOPMENT:Z4
(To be filled in b ro ert owner proposing development
d _. , A 2
(Information for Property Owner Applying
for Permit)
ailing Address
City/State/Zip
Telephone Number
Signature Date
(Riparian Property Owner Information)
Signature
OaAle S L271,41--le
Print or Type Name
Telephone Number
�— 2 05
Date

WILLIAM A.
BETSY E. GUTHRIERIE
p p 155093Box 31 B h 225e 72n&2920
Harkers Island, NC 28531
Pay to the C D
Order of ,
2651
66-21/530
�y BRANCH 77513
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Dollars �,•��•°°
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