34577_GARDNER SR, JACK_20030710

ACAMA / n DREDGEn& FILL
GENERAL PERMIT _ Previous permit �r
1-.]New i._ Modification jComplete 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 NameProject Location: County
Address_ T, /216 q sr S'l Street Address/ State Road/ Lot #(s) ;✓ �G'y
City cz„��. ` State, 't.k ZIP ?<i r16
Phone # (?fl)' 77 f V S 30 Fax # () Subdivision
Authorized Agent
Affected 12 CW ;RrEW LAPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes 6/ ) Crit. Hab. yes / no
City • c ZIP
Phone # ( 3c- River Basin
Adj. Wtr. Body_ ���,i /G� r Z -y E . i. (nat /man /unkn)
Closest Maj. Wtr. Body ��✓ ��� ' �``�
Type of Project/ Activity rU r X ? Z Oe;
! Cr.
(Scale:
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap
avg distance
max distanc
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatli
Beach Bulldozing
Other
�2�
Shoreline Length
SAV: not st
Sandbags: not st
Moratorium:
Photos:
Waiver Attached:
yes no
A building permit may be required by:
Notes/ Special Conditions
! ( /
0 M�
Agent or Appj(cant Printed Name
Signature * Please r �d compliance sent on back of permit
Application Fee(s) 0 Check #
❑ See note on back regarding River Basin rules.
w rT N
.i/
Permit Officer's Signature ,
Issuing Date Expiration Date
r .: -4
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, 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
❑ Neuse River Basin Buffer Rules
❑ Other:
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.nccoastaimanagement.net
Revised 10/05/01

6� 3ys7 7 , �, �.a�•t�
NO MA M. GARDNER 01/88 14 ( A,J SQ4r6411 9454
1199 Hlh/Y 101 03 BEAUFORT, NC 28516 ow' l,68-426/514
30301
1�
2601:51358088

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to W IGuArn J. ,S(1. 's
(Name of Property Owner)
property located at
V—
on Ti -IL CfU�IL
(Waterbody)
109 C 12On1T�T•
(Lot, Block, Road, etc.)
in 13C'A 04fZT- (fA2JJI2FT-2 / , N.C.
(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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
SE. ATfA-coo
:4i-- ?�
Sign ture
1205A L,1 E M . 5A L-TIE-A
Print or Type Name
-12-? - 4-S 7-S
Telephone Number
Date: s /7�f

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