34794_DORSEY, RONALD_20030910

I-- CAMA 171 DREDGE & FILL
GENERAL PERMIT
Previous permit #
F— New ElModification —]Complete Reissue ElPartial 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
' I Rules attached.
Applicant Name 1)
Address
(v k, k' IQ,
City Qrmhi ,fx
State A& ZIP
Phone # -7
Fax #
Authorized Agent
Affected El CW
Ll EW
PTA El ES ❑I PTS
AEC(s): C OEA
I HHF
C 1H El UBA D N/A
El PWS:
0 FC:
ORW: yes / no
PNA
yes / no Crit. Hab. yes no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone# River Basin 4'/'/
Adj. Wtr. Body /-os,, Pk-i(A-e i,& o& (nat /Ka-'n /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity r"
- 0',
"
(i
.&I
(Scale:
IV
cry
U 0-
Pier dock), length
Plad )rm(s)
Fing r pier(S)---
ME
NEW
ME
0
0
MINE
MENEM
IMEM
0
MEN
Groi i length
MIMME
M
OEM
number
No
Bulklead/ Riprap length
IBM
0
ILE
avg distance offshore
max distance offshore
Basin, channel
cubic yards__
Boat ramp
Boat ouse/Boatlift tl�or.f)('d
Erin
FIAPA
MEN
MONISM
0
mom
Beac.-i Bulldozing
Oth
IMMEMEMMEMEM
ShoAline Length
SAM not sure yes 'no
Sand6ags: not sure yes no
MorZtorium: n/a yes no
PhotL 5: yes no
Wail AttacWed- 0
--ME
A building permit may be required by:
El See note on back regarding River Basin rules.
Notes/ Special Conditions
WC11L 4iq�- 2
k PtiU' j -"VA 4141,
J,
4,J JJ�J'
Permit
Agent or Applicant Printed Narno
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Officer's Signature
Expiration Date
A41064�1 gV11 )(1
Y/m
Local
Issuing Date
L
Planning Jurisdiction Rover File Name
Agent or Applicant Printed Narno
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Officer's Signature
Expiration Date
A41064�1 gV11 )(1
Y/m
Local
Issuing Date
L
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 [)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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
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)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
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
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

THIS MULTI -TONE AREA OF THE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY FROM DARK TO LIGHT WITH DARKER AREAS BOTH TOP AND BOTTOM
NOT VALID OVER $1.000.00
ISSUING BRANCH_
DATE
PAY 10 iL��
ORDER OFF
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93-541 /920
ry 'Jl }HINl1 YOU AGREE TO THG SERVICE CHARGE
R�� � ��� ! ) O(HCR TERMS ON THE REVERSE SIDE
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AP
I�i�A �-IASI J?FGR DRAW ER
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(FOR A PrEpvL'NC'OVF ED BOAT LJIFn
Z hereby c.--t;ify that I own property zdiacznc to or�
C t �003 ciJ e �r 'p'rpP-t rt� o)
jvrepeYty located at _ �.�.A N r� Jt e ti f .. _� ��
(f-4X, Block, Road, etC.)
on fow (h in N.C.
(%Vaterbudv) (Towu aodlor Coumty)
He has des,: 'be to me, as shown below, the deve.'oprtienr, he is proposing at that
location, and, I nave no obj---tions to his pro_oosaI. I understand til,ac a pier/uncovered boat Uf:
must be set back a minimum distancw of Or ccn re~t (15') from my j.i:= of ripazia.n access un1G55
waived by me.
I dg Dgtt wish to wmvt the secbacic t2auireHoyt.
1/ I dQ wish to waive that Setback requirement.
------ ------- ------------------- ------------ ------------- --------------------.----•_------
DESC1 D-hON A-Iv-D/OR DRY,tiV—LiG OF PRO POSEDI DEIvET0P-ND-7N -:
(To be jffUed in kv in-div&ucl ,proposing devel r
merit)
ell
1
1 �
o C K 1✓
_ LJ j
Signature '
�,��� r/� _` ��l - - Ste'•' ��
Print or 7ypc Nagnt
Telephone Numbs r
z-d 9909-2et'-2S2 'd'd `gimiQd del tz0 co B0 daS

(FOP. A PIEFUUNCOVERED BOAT LIIM
S�7 Q Zoo; Kerr -by c-T: fy that [ own property adiac-nt to S,
a of proven" d vrner}
properry located a(-- `O QW�%J 4az
(Lot, Block, Road, etc.)
in Lfii�Ls4�.C.
(Vlaeerb�ay) — (Toga andlorCounty)
He has desr;rtbed to me, as shoKz below, the dev:t!oprrient he is proposing at tr:at
loc sadca, and, i have no vojt--cions to his proposal- f understand �ac a picduncovered beat lif:
must be se, back a minimum distance or tire` t fe~t (:.S') xrorn my Fn of riparian a=-53 unless
wa,ivrd by mc.
I do not wish to waiv-- the whack renuiMMCM.
x I dp wish co waive that setback :evuitemenr_
DESCKQ''M A N-DIOR DRAWUiG OF PROPOSW DEVELO>?'tiz "T.
(To be jWed in ky individual proposing devez 7pment)
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Date:
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