34536_DURHAM, JUNE_20030806

�CAMA / ❑DREDGE &FILL
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GENERAL PERMIT Previous permit#
UNew ❑Modification ❑Complete Reissue ❑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 15A NCAC
❑ Rules attached.
Applicant Name
Address
3
City State ZIP
Phone # 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
Type of Project/ Activity
Pier (dock) length i v i,
Platform(s)_
Finger pier(s)
Groin length
number
Bulkhead/ Rip
avg distz
max dist
Basin, channe
cubic ya
Boat ramp _
Boathouse/ B,
Beach BUIldo2
Other
Shoreline Len
SAV: ni
Sandbags: n4
Moratorium:
Photos:
Waiver Attacl
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body , i , • r (nat /man /unkn)
Closest Maj. Wtr. Body J C(
(Scale: )
A building permit may be required by: f n ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
eve- '"t,Gs 6f -. (ID nic
Agent or Applicant Printed Name
Signature ** Please
}}read compliance statement on back of permit
l ('
LC}
Application Fee(s) Check #
LA,)
'Permit Officer's Signature
1.
IssuingDate : /+ 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:
❑1 TTar- Pamlico River Basin Buffer Rules ❑ Other:
U 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 / 1-888ARCOAST
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

ODONALD R. OXENDINE NCDL 3584956 1 061
DONNA O. MOLINA NCDL 8050154 6r�7704/2531
Phone [phone]
5114 Kershaw Road
Oriental, NC 28571 re
Pay to rlic
Oracrof
State Employees' Credit Union
New Bern, North Carolina
34 j5vs,36
rhn iM-. In
1: 2 5 3 17 70491:086 309486
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79111 106 L
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(FOR A PIERIMOORING PILiNGS/BOATUMBOATHOUSE)
I hereby certify that I own property adjacent to V-\
(flame of Property Owner)
S
property iocated at
7/
(I.,ot, Block, Road, etc.)
in i— ll�c� N.C.
(Waterbody) (Town and/or County)
He has described to rae, as shown below, the development he is proposing a, 'ha,
location, and, I have no objections to his proposal. I understand that a pier/mooring
oilinp-s/boattift/boathouse must be setback a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me -
I dg ul wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIMON k'l,3D;OR ORjk'%* utiG OF PROPOSED DEVELOPA'41'EA NT:
Mo be 171led in b► individual Proposing development)
15
il-
E:1
ignature/�'
1 01rrcJ 0►-Toc-n i^rdm m
Print or Tvne Name
T clephone ivunibei
Date.

ADJACENT RWAIDJA d PROPERTY MINER TA'TENLEE, ?'r'
(FOR A PIERIhro©RING PiLiNGSIBOATLIF?7BOATHOUSE)
r 2.
-xby ;A fy that 1 open property --c eanf to
1 lIGI wawa as ia...a.a � � � r'• . Q,WI
(Name of Property Owner)
property iocated at
7/
f) t, (1-40, Block, Road, etc.)
on cam, �c�r� �. g ems%. in _6 t--" 1 eX 1� c�� N.C.
(6'ir'aterbody) (Town and/or County)
11r, hau ue-scel cd to rye, as Show,-, below, the devOop„ent. iic is proposing of
location, and, I have no objections to his proposal. 1 understand that a pier/mooring
pilinQsiboatliftiboathouse must beset backs minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I o nQ1 wish to waive the setback requirement,
I dQ wish to waive that setback requirement.
------------ _---------------- -----------------------
DESCRU irON A"N'D OR DR"" MT G OF PROPOSED DE".IELO :LINM
(7'0 he,1illed in by indnidual proposing development)
8�
L.Jo.\� �a►.y
--------------------------- -- -----------------
`! Signature
Print or Type Marne
`T ciepiivnc Number
Date. ��� /:�2 3
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