32908_FORDHAM, MELVIN_20021029

i -_l CAMA / DREDGE & FILL
GENERAL PERMIT
New LJModiflcation Complete Reissue Tartial 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 15A NCAC
Applicant Name Me l u o i L r cl i s #A
Address i 7 0 0, t �Wo y W' 2% 6 s `. r L
CiState 4f ZIP �65o9
Phone # (252 ) 523 `jc, 75 Fax # (`
Authorized Agent 11s r.,IJ
Affected ❑ CW O EW © PTA O ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes /isno PNA yes / no Crit. Hab. yes / no
Previous pe'filoit#
Date previous permit issued
32908-t
EE Rules attached.
Project Location: County i rs r '{, , F fi
Street Address/ State Road/ Lot #(s)
k Fd`)`
Subdivision c
City! .t r l401 It, a ZIP zv 5,641 --
Phone # ( ) River Basin OYA :;r 6 r-
Adj. Wtr. Body n.mnt- ofvi t rli JAP i gnat /man Junkn
Closest Maj. Wtr. Body r i'C-40,el
Type of Project/ Activity tea, cJ (/ k
(Scale: AZcw4 )
Pier (dock) length _ —
Platform(s)
Finger pier(s) I I
Groin length
number
Bulkhead/ Riprap length =.'s,-
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ram p
Boathouse/ Boatlift I
Beach Bulldozing — - —
Other, —
Shoreline Length
SAV: 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 <<i
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River (tBasin rules.
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on
back
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Agent or Applicant Printed Name ,
Signature Please read compliarice statement on back of permit
1 :I
Application Fee(s) Check #
Permit Officer's Signature
Issuing Date J
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 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, certifythat this 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 / 1-888-4RCOAST
Fax: [phone]
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead Cif 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

UNITEDSTATES
r POSTAL MONEY ORDER
POST/JL SERVICE®
90872689274 ;!
SERIAL NUMBER YEAR MONTH DAV POST OFFICE U.S. DOLLARS AND CENTS
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PAY TO
CHECKWRI7ER 'e•,.\ I �'i'
IMPRINT AR
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AD
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C.O.D. NO. OR to
USED FOR(yi- l.•l� 6
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1:00000800 21: 908 7 2 58 9 2 ? Lot,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to S
(Name of Property Owner)
property located at -- '
(Lot, Block, Road, etc
on C-If-n ��rn� (� �R�� , N. C.
(Wat ody) ( own 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signature
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Print 4orTy Name
Telephone Number
Date: �'_' �—

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AI)jACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I awn property adjacent to
(i;anrte of Property Owner)
property located at L
(Lot, Block, Road, etcon n
(Wat . ody) ( own and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, .1 have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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�r
--------------------------- -�----------- - - - -
Signatl,,- .7
Pririt or Type Name
Telephone Number
Date: ---