30593_FORD, BARBARA_20030926

LAMA / ' DREDGE & FILL
GENERAL PERMIT
New Modification Complete Reissue Partial Reissue
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
Applicant Name
Address
City _ _ State__ ZIP
Phone # (_ ) f;, Fax # O
Authorized Agent r , jt ;
Affected CW `T,EW 1 ❑ PTA -ES ❑ PTS
AEC(s): OEA b HHF ❑ IH UBA C N/A
PWS: C FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
Groin length _
number
Bulkhead/ Riprap length
avg distance offshore
-
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant PrintedName
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Illy
Previous permit #
Date previous permit issued
-' Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s) f + f
Subdivision
City _.
Phone # ( )
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIPr---
_ River Basin
(nat /man /unkn)
(Scale: )
J; r
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date
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 thatthis project is consistentwith 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 Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza 11
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)
Revised 10/C

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SEA LEVEL, NC 28577
Pay To The
Order Of
ollars
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Wachovia Bank, N.A.
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ADJACENT SARAN ]PROPERTY OWNER STATEMENT
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I hereby certify that I own property adjacent to Wiva L. 6A 's
(Naive of Property Owner)
property located at bit N o-kSoi i 1 ec N��, q% (; ()3 4 3 42 q 3 (LEc,� �4escrip�'��•J
(Lot, Block, Road, etc.)
on(if��fJ�t-1� , in Jplf12�{� f I �`fQ�2� , 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.
_k 4 DA?j
DESCRIPTION AND/OR DRAWING OF
t (To be,dlled in by individual pn
Gil
OSED DEVELOPMENT
development)
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Signature
R;c�,(->Yd &A�e�
Print or Type Name
Telephone Number
Date:

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PostagPd)N
Certified Fla
Return Reciept F(Endorsement RequireC]
Restricted Delivery Fp
(Endorsement RequrzeLrlM
Total Postage & Fe
Sent -v , L -X Ai�
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(ti Street, Apt. No.; n ( O
or PO Box No. r_ (Q
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit: 9 G L Fpiz�
Address of Property: �' (� �QIS�N 1VCA QA
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestron Plaza H, 151-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Q, J
Sigu4turg � / Date
�c``2ai' NCB e
Print Name
e19I
Telephone Number With Area Code

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et �+ t�rih'i�itih���dhh�+thht,�d„nttf��lnird><)lilt,�lttrn�tldtt;lt>iL,t,�l�rr,hit�fid�,,,,,�h�;�i.
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
13� Ily Mar�i>1
(p� MaY-�h Lane
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❑ Agent
❑ Addre
B. Receiveb,15y ( Printed Name) C. DO) of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. §er.Naw Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) p Yes
2. (Ficlens Number ) r� D V 3 0 5 o 0 y h 8 3gI r' 4
ransfer from service label �D V � tO
PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540
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1:3 Postage $ r
et
ED Certified FeeE3 4jj
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Return Reciept Fee C� — rrjr � O
(Endorsement Required)' 6�are
O Restricted Delivery Fee
E3 (Endorsement Required)
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Total Postage & Fees
mO Sent To
k.. N�a� :h-------------------------------------------------
r` Street, Apt No.;
or PO Box No. D
ziP«a Ma's Y! J ! .....................
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual applying for Permit:��
Address of Property: (Pit
a.0
(Lot or Street #, Street or Road, City & County)
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
I / I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coastal
Management, Hestron Plaza 11, ISI-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808-
2808 within 10 days of receipt of this notice. No response is considered the same as no objection
if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Signature Date
�ikq�a��rc -
Print Name
Telephone Number With Area Code

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to [--�Ybgfa L. Fed 's
(Name of Property Owner)
property located at l i l ie iScw i ecy QA' 4 Zq 3 (JGJ 0scgbA)
(Lot, Block, Road, etc.)
on cNe Sov N 0 , in _-Qeat e V e Cq Y-{ ve-+ , 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
'ION AND/OR DRAWING OF
(To be filled in by individual pn
tik6-111 A"�-
Signature
DEVELOPMENT
development)
31310
Pi c on Lon,
& 1 ! u Ma✓-h
Print or Yype Name
Telephone Number
Date:

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MONITORING & COMPLETION REPORT
[LAMA Major Development & State Dredge & Fill Permits]
PERMITTEE' S NAME:
LOCATION: ( r I I ,
PHONE: L1 r l
DATE OF INSPECTION 3
C
PERMIT # 3 —C
FIELD REP. -�/ ;�
DATE REPORTEDLY COMPLETE:
1) Do th'�neasured dimensions of the development differ from those indicated in the permit and workplat?
YES/[circle one].
COMMENT:
2) SEDIMENTATI EROSION CONTROL: Has Permittee seeded, grassed, or otherwise stabilized all
disturbed areas? ; / O [circle one]
COMMENT:
3) FUTURE MONITORING & ENFORCEMENT ACTION: Is further investigation or enforcement action
needed? YES/NO [circle one].
COMMENT: