34053_FOSE, DONALD_20030606

► JCAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous /permit
#
❑New ❑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 I SA NCAC i 1
❑ Rules attached.
Applicant Name
Address
City ?wo,V:', State ZIP
Phone # Fax # O
Authorized Agent
Affected ❑ CW ❑ EW M.PTA ❑ ES ❑ PTS
AEC(s): —1 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Project Location: County i �; j �..•..
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) _ River Basin
Adj. Wtr. Body t'�a-i<t.< i�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
i s
Issuing Date 1i Expiration Date
` r
Local Planning] urisdiction 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 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 / 1-888ARCOAST
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.nccoastaimanagement.net
Revised 10/05/01

IV
DONALD FOSE JR
KATHLEEN D FOSE
Ph 910-989-3350
8 Bayview Dr
Jacksonville, NC 28540
THE
OF
yti� �Jti
CARMNA RMT
JACKKSSONVILLE, NC 28540
FOR
l:OS3902197i:B LOOS 29 2061I'
1738
R
67-219/539
BRANCH 01410
DATE
F..dl is on
Baclllv

ADJACENT RLPARL�I,t PROPERTY OVVINER STATEN ENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adiacent to De
),,JA
_ 5
(Name of Property Owner)
property located at ,.., A 1
(Lot,'Block, Road, etc_)
on I5a„� �.
k A �' , in
(Waterbod(Town N.C.
Town and/or County)
He has described to me, as <; oSNn beio,;:, hC development he i
and, I have no objectionss proposer._ a. that location,
to his proposal_ I understand tha_ �a pie:/Moor*ng
piiings,'boatlift/boathouse must be se: back a minimum distance of frftetn feet (15•) from my area
of riparian access unless waived by me.
I do not wish to waiv.- the setback requirement.
I d_Q wish to waive that setback re uirement.
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IA
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DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEti-ELOPNILti-T:
?ptN!' (To befij_le fq by individual proposing development)
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H� A.
Na
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�1 Gi'tL. Print or Tye N p ame
Telephone Number
., . Date: S

•
'Ij
.? PL�'� PROPERTY OWNER STATEI[E -T
(FOR A PIERIMOORING PILINGS/BOATLIFT/BOATHOUSt)
I hereby certify that I own property adiacent to De -WA IA Fos -c is
(Name of Property Owner)
prope.-y located at g ��lyy�e,,, � "�'�' ' a ' i c. �V% C. zg,f- 0
(Lot. Block, Road, etc_)
on W,Is�r3 e A �t 'in G*J/w
(Waterbody) I (Town and/or ounty)
ISe has described to me, as shown below, the development he is propos-,:-.7 a: tat location,
and, I have no objections to his proposal. I understand that a pier/mooring
pirmsis/boattift/boathouse must be se: back a minimum distance of fifteta fee: (i.5') from my area
of riparian access unless waived by me.
I do not wish to waiv.- the setback requirement.
_LZ I d_Q ,vlsh to waive tsar setback recuire;, e �t.
�_ oweA-
r4Ct>
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r4 DESCRIPTION AND/OR DRAWLNG OF PROPOSED DEVELOPNIr\ i :
9 (To be JUIed in by individual proposing development)
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Si nature
Print or Tvz Name
/ 3 5 �c00
Telephone Ni.:rnber
Date: :ZC7